Provider Demographics
NPI:1891345104
Name:BAY CITY ASSOCIATES IN PODIATRY INC
Entity Type:Organization
Organization Name:BAY CITY ASSOCIATES IN PODIATRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:RUSSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-864-2360
Mailing Address - Street 1:3850 WALKER BLVD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-1627
Mailing Address - Country:US
Mailing Address - Phone:814-864-2360
Mailing Address - Fax:814-864-2383
Practice Address - Street 1:105 MEAD AVE STE A
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-3531
Practice Address - Country:US
Practice Address - Phone:814-337-3668
Practice Address - Fax:814-337-3368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty