Provider Demographics
NPI:1801950001
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:
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 1:900 WATER ST
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-3428
Practice Address - Country:US
Practice Address - Phone:814-332-0024
Practice Address - Fax:814-332-0029
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAY CITY ORTHOCARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-21
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA6000006121332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019531980003Medicaid
4681740002Medicare NSC