Provider Demographics
NPI:1740949700
Name:BAYVIEW MEDICAL SUPPLY LLC
Entity type:Organization
Organization Name:BAYVIEW MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRYSOSTOME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-982-9049
Mailing Address - Street 1:3700 34TH ST STE 302C
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32805-6601
Mailing Address - Country:US
Mailing Address - Phone:800-982-9049
Mailing Address - Fax:
Practice Address - Street 1:3700 34TH ST STE 302C
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805-6601
Practice Address - Country:US
Practice Address - Phone:800-982-9049
Practice Address - Fax:321-250-5424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-16
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies