Provider Demographics
NPI:1831648203
Name:BAY CARDIOVASCULAR SURGERY PA
Entity Type:Organization
Organization Name:BAY CARDIOVASCULAR SURGERY PA
Other - Org Name:BAY VASCULAR SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOFTON
Authorized Official - Middle Name:NATHANIEL
Authorized Official - Last Name:MISICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-761-8610
Mailing Address - Street 1:ID#1177
Mailing Address - Street 2:PO BOX 659506
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78265-9506
Mailing Address - Country:US
Mailing Address - Phone:361-761-8610
Mailing Address - Fax:361-761-8611
Practice Address - Street 1:819 AYERS ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-1914
Practice Address - Country:US
Practice Address - Phone:361-761-8610
Practice Address - Fax:361-761-8611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-27
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2086S0129X, 208G00000X
TXQ7428208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX367177801Medicaid