Provider Demographics
NPI:1598876252
Name:BAY VALLEY INTERNAL MEDICINE PLLC
Entity Type:Organization
Organization Name:BAY VALLEY INTERNAL MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:FRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SKELTIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-686-8100
Mailing Address - Street 1:4818 W PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-2844
Mailing Address - Country:US
Mailing Address - Phone:989-686-8100
Mailing Address - Fax:989-686-8109
Practice Address - Street 1:4818 W PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-2844
Practice Address - Country:US
Practice Address - Phone:989-686-8100
Practice Address - Fax:989-686-8109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2007-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0P37620Medicare PIN
G34700Medicare UPIN