Provider Demographics
NPI:1841477890
Name:BAYFRONT PHYSICIAN SPECIALTY SERVICE
Entity type:Organization
Organization Name:BAYFRONT PHYSICIAN SPECIALTY SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:RICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-893-6223
Mailing Address - Street 1:701 SIXTH ST. S.
Mailing Address - Street 2:
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4891
Mailing Address - Country:US
Mailing Address - Phone:727-893-6283
Mailing Address - Fax:727-893-6914
Practice Address - Street 1:603 SEVENTH ST S
Practice Address - Street 2:SUTIE 450
Practice Address - City:ST. PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4891
Practice Address - Country:US
Practice Address - Phone:727-893-6283
Practice Address - Fax:727-893-6914
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAYFRONT MEDICAL CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-22
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00181560Medicaid
FLEH658AMedicare PIN