Provider Demographics
NPI:1720078041
Name:BAY COUNTY HEALTH SYSTEM, LLC
Entity Type:Organization
Organization Name:BAY COUNTY HEALTH SYSTEM, LLC
Other - Org Name:ASCENSION SACRED HEART BAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHAN
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:QUIRICONI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-308-1258
Mailing Address - Street 1:615 N BONITA AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-3623
Mailing Address - Country:US
Mailing Address - Phone:850-747-6045
Mailing Address - Fax:850-763-8827
Practice Address - Street 1:615 N BONITA AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-3623
Practice Address - Country:US
Practice Address - Phone:850-747-1511
Practice Address - Fax:850-747-6842
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAY COUNTY HEALTH SYSTEM, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-27
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3982282N00000X
FL2896341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010006400Medicaid
FL056445100Medicaid
FL033526600Medicaid
FL088052300Medicaid
FL419OtherBLUE CROSS PROVIDER NUMBE
FL596001478OtherTRICARE
FL162945400OtherUS DEPT OF LABOR
FL10-0026Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
FL0026Medicare PIN