Provider Demographics
NPI:1609930676
Name:BAYWOOD MEDICAL ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:BAYWOOD MEDICAL ASSOCIATES, PLLC
Other - Org Name:DESERT PAIN INSTITUTE - ASC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN-PARTNER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-325-3801
Mailing Address - Street 1:PO BOX 13550
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85216-3550
Mailing Address - Country:US
Mailing Address - Phone:480-325-3801
Mailing Address - Fax:480-325-3805
Practice Address - Street 1:6309 E BAYWOOD AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-1744
Practice Address - Country:US
Practice Address - Phone:480-325-3801
Practice Address - Fax:480-325-3805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOSC-3134261QA1903X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ712308Medicaid
AZ71425Medicare ID - Type Unspecified