Provider Demographics
NPI:1568466209
Name:BAYVIEW MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:BAYVIEW MEDICAL CENTER, INC
Other - Org Name:LMC AMBULATORY SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:CETRONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-686-3508
Mailing Address - Street 1:PO BOX 7068
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-0068
Mailing Address - Country:US
Mailing Address - Phone:757-686-3508
Mailing Address - Fax:757-686-0541
Practice Address - Street 1:2000 MEADE PKWY
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-4259
Practice Address - Country:US
Practice Address - Phone:757-934-9329
Practice Address - Fax:757-923-9648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-10
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAOH660261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0721098OtherCIGNA #
VA227048OtherANTHEM BCBS #
VA7600097Medicaid
NC4909895Medicaid
VA655693OtherNCPPO #
VA490002226OtherRAILROAD MEDICARE
VA556665OtherMAMSI #
NC4909895Medicaid