Provider Demographics
NPI:1689850042
Name:BAY HARBOR MED CENTER
Entity Type:Organization
Organization Name:BAY HARBOR MED CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VERA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEATLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-453-7122
Mailing Address - Street 1:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:BURGESS
Mailing Address - State:VA
Mailing Address - Zip Code:22432-0400
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:740 JESSIE DUPONT MEM HWY
Practice Address - Street 2:
Practice Address - City:BURGESS
Practice Address - State:VA
Practice Address - Zip Code:22432-0400
Practice Address - Country:US
Practice Address - Phone:804-453-7122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VACO5610Medicare PIN
VA110008458Medicare PIN