Provider Demographics
NPI:1740445865
Name:GULF BAY DIAGNOSTICS LLC
Entity type:Organization
Organization Name:GULF BAY DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:M
Authorized Official - Last Name:RIZZUTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-228-1467
Mailing Address - Street 1:25922 TEALWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-6429
Mailing Address - Country:US
Mailing Address - Phone:251-228-1467
Mailing Address - Fax:251-980-1945
Practice Address - Street 1:25922 TEALWOOD DR
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-6429
Practice Address - Country:US
Practice Address - Phone:251-228-1467
Practice Address - Fax:251-980-1945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty