Provider Demographics
NPI:1578844080
Name:BAYSIDE ORTHOPAEDIC & REHABILITATION CENTER, P.C.
Entity Type:Organization
Organization Name:BAYSIDE ORTHOPAEDIC & REHABILITATION CENTER, P.C.
Other - Org Name:BAYSIDE ORTHOPAEDIC, SPORTS MEDICINE & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-928-2401
Mailing Address - Street 1:PO BOX 1186
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36533-1186
Mailing Address - Country:US
Mailing Address - Phone:251-928-2401
Mailing Address - Fax:251-928-5099
Practice Address - Street 1:100 LEWIS ST
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:AL
Practice Address - Zip Code:36401-3317
Practice Address - Country:US
Practice Address - Phone:251-928-2401
Practice Address - Fax:251-928-5099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-30
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL528700580Medicaid
AL0285740001Medicare NSC