Provider Demographics
NPI:1013116748
Name:BAYSPINE SURGERY CENTER LLC
Entity Type:Organization
Organization Name:BAYSPINE SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:W
Authorized Official - Last Name:SHORTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-243-2130
Mailing Address - Street 1:3065 RICHMOND PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94806-5719
Mailing Address - Country:US
Mailing Address - Phone:510-243-2130
Mailing Address - Fax:
Practice Address - Street 1:3065 RICHMOND PKWY STE 100
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94806-5719
Practice Address - Country:US
Practice Address - Phone:510-243-2130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical