Provider Demographics
NPI:1477656619
Name:BAY WALK IN CLINIC, INC
Entity Type:Organization
Organization Name:BAY WALK IN CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-763-9744
Mailing Address - Street 1:2306 HIGHWAY 77
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4404
Mailing Address - Country:US
Mailing Address - Phone:850-763-9744
Mailing Address - Fax:850-785-2020
Practice Address - Street 1:2306 HIGHWAY 77
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4404
Practice Address - Country:US
Practice Address - Phone:850-763-9744
Practice Address - Fax:850-785-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTRICARE-TOWN
FL=========001OtherTRICARE-BEACH
0617220003Medicare NSC
FL=========OtherTRICARE-TOWN
FL=========001OtherTRICARE-BEACH
FL97153Medicare ID - Type UnspecifiedMEDICARE NUMBER
0617220002Medicare NSC
FLCA5083Medicare ID - Type UnspecifiedRAILROAD MCARE-TOWN