Provider Demographics
NPI:1861675787
Name:BAY CENTRAL NEUROLOGY INC
Entity Type:Organization
Organization Name:BAY CENTRAL NEUROLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:UNGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-471-0324
Mailing Address - Street 1:2575 ULMERTON RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33762-2283
Mailing Address - Country:US
Mailing Address - Phone:727-471-0324
Mailing Address - Fax:727-471-0329
Practice Address - Street 1:2575 ULMERTON RD
Practice Address - Street 2:SUITE 300
Practice Address - City:ST. PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33762-2283
Practice Address - Country:US
Practice Address - Phone:727-471-0324
Practice Address - Fax:727-471-0329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME859882084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269986900Medicaid
FL269986900Medicaid