Provider Demographics
NPI:1942207121
Name:BAY CITY ORTHOCARE LLC
Entity Type:Organization
Organization Name:BAY CITY ORTHOCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:L
Authorized Official - Last Name:DESARRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-452-4632
Mailing Address - Street 1:2313 PEACH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-2822
Mailing Address - Country:US
Mailing Address - Phone:814-452-4632
Mailing Address - Fax:814-452-4636
Practice Address - Street 1:2313 PEACH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-2822
Practice Address - Country:US
Practice Address - Phone:814-452-4632
Practice Address - Fax:814-452-4636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA6000006121332B00000X
335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019531980003Medicaid
PA001428224OtherBC HIGHMARK
PA0019531980003Medicaid