Provider Demographics
NPI:1679724488
Name:BAYCARE MEDICAL GROUP PEDIATRIC WALK-IN, LLC
Entity Type:Organization
Organization Name:BAYCARE MEDICAL GROUP PEDIATRIC WALK-IN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TOMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:INZENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-636-2044
Mailing Address - Street 1:PO BOX 743409
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3409
Mailing Address - Country:US
Mailing Address - Phone:727-532-0002
Mailing Address - Fax:727-532-1325
Practice Address - Street 1:4902 EISENHOWER BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-6310
Practice Address - Country:US
Practice Address - Phone:813-636-2044
Practice Address - Fax:813-321-6998
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAYCARE MEDICAL GROUP, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-10
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty