Provider Demographics
NPI:1467489609
Name:BAYCARE HOMECARE INC
Entity Type:Organization
Organization Name:BAYCARE HOMECARE INC
Other - Org Name:BAYCARE HOMECARE INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHCY DIR
Authorized Official - Prefix:
Authorized Official - First Name:IQBAL
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:727-394-6577
Mailing Address - Street 1:8452 118TH AVE
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33773-5007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8452 118TH AVE
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773-5007
Practice Address - Country:US
Practice Address - Phone:727-394-6585
Practice Address - Fax:727-394-6542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH190553336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1070541OtherNCPDP PROVIDER IDENTIFICATION NUMBER
4641400001Medicare NSC