Provider Demographics
NPI:1619923158
Name:BAY CENTER FOR PAIN MANAGEMENT PA
Entity Type:Organization
Organization Name:BAY CENTER FOR PAIN MANAGEMENT PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IMTIAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:HOSSAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-588-0366
Mailing Address - Street 1:101 CLEARWATER LARGO RD N
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-2357
Mailing Address - Country:US
Mailing Address - Phone:727-588-0366
Mailing Address - Fax:727-588-0370
Practice Address - Street 1:101 CLEARWATER LARGO RD N
Practice Address - Street 2:SUITE 2
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-2357
Practice Address - Country:US
Practice Address - Phone:727-588-0366
Practice Address - Fax:727-588-0370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK2740Medicare ID - Type Unspecified