Provider Demographics
NPI:1629241690
Name:BAYVIEW OB/GYN, PC--MIDWIFES
Entity Type:Organization
Organization Name:BAYVIEW OB/GYN, PC--MIDWIFES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EVE
Authorized Official - Middle Name:M
Authorized Official - Last Name:RIDER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:231-487-2340
Mailing Address - Street 1:560 W MITCHELL ST
Mailing Address - Street 2:STE 210
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2275
Mailing Address - Country:US
Mailing Address - Phone:231-487-2340
Mailing Address - Fax:231-487-2115
Practice Address - Street 1:560 W MITCHELL ST
Practice Address - Street 2:STE 210
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2275
Practice Address - Country:US
Practice Address - Phone:231-487-2340
Practice Address - Fax:231-487-2115
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAYVIEW OB/GYN, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI420B41027OtherBCBS MI