Provider Demographics
NPI:1629323076
Name:BAYFRONT MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:BAYFRONT MEDICAL CENTER, INC.
Other - Org Name:BAYFRONT PATHOLOGY LAB
Other - Org Type:Other Name
Authorized Official - Title/Position:SENIOR VP FINANCE & CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:THORNTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-893-3250
Mailing Address - Street 1:701 6TH ST S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4814
Mailing Address - Country:US
Mailing Address - Phone:727-893-1234
Mailing Address - Fax:727-893-6961
Practice Address - Street 1:701 6TH ST S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4814
Practice Address - Country:US
Practice Address - Phone:727-893-1234
Practice Address - Fax:727-893-6961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-20
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4303291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010156700Medicaid
FL010156701Medicaid
FL010156701Medicaid
FL10-T032Medicare PIN