Provider Demographics
NPI:1578644431
Name:BAY PINES VA HEALTH CARE SYSTEMS
Entity Type:Organization
Organization Name:BAY PINES VA HEALTH CARE SYSTEMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL SCIENCE PROGRAM SPECIALIST
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:WARE
Authorized Official - Suffix:
Authorized Official - Credentials:CCAC
Authorized Official - Phone:727-398-6661
Mailing Address - Street 1:1000 BAY PINES BLVD DOM C184
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33744
Mailing Address - Country:US
Mailing Address - Phone:727-398-6661
Mailing Address - Fax:727-398-9509
Practice Address - Street 1:1000 BAY PINES BLVD DOM C184
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33744
Practice Address - Country:US
Practice Address - Phone:727-398-6661
Practice Address - Fax:727-398-9509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1307261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)