Provider Demographics
NPI:1700126521
Name:BAY CITY PHYSICAL MEDICINE, P.A.
Entity Type:Organization
Organization Name:BAY CITY PHYSICAL MEDICINE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:E
Authorized Official - Last Name:BERTONI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:979-245-1414
Mailing Address - Street 1:1221 AVENUE F
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77414-3413
Mailing Address - Country:US
Mailing Address - Phone:979-245-1414
Mailing Address - Fax:979-245-1555
Practice Address - Street 1:1221 AVENUE F
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:TX
Practice Address - Zip Code:77414-3413
Practice Address - Country:US
Practice Address - Phone:979-245-1414
Practice Address - Fax:979-245-1555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-15
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE5682208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty