Provider Demographics
NPI:1750704870
Name:BAY CITY ORTHOCARE, LLC
Entity type:Organization
Organization Name:BAY CITY ORTHOCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:L
Authorized Official - Last Name:DESARRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-452-4632
Mailing Address - Street 1:2313 PEACH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-2822
Mailing Address - Country:US
Mailing Address - Phone:814-452-4632
Mailing Address - Fax:814-452-4636
Practice Address - Street 1:560 W 3RD ST
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-4776
Practice Address - Country:US
Practice Address - Phone:716-483-0289
Practice Address - Fax:716-483-0292
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAY CITY ORTHOCARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-24
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies