Provider Demographics
NPI:1881434868
Name:BAYVIEW MEDICAL CENTER, INC
Entity type:Organization
Organization Name:BAYVIEW MEDICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BAMIDELE
Authorized Official - Middle Name:
Authorized Official - Last Name:EKUNSANMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-356-3400
Mailing Address - Street 1:206 BURWASH AVE
Mailing Address - Street 2:
Mailing Address - City:SAVOY
Mailing Address - State:IL
Mailing Address - Zip Code:61874-9510
Mailing Address - Country:US
Mailing Address - Phone:217-356-3400
Mailing Address - Fax:217-866-0122
Practice Address - Street 1:206 BURWASH AVE
Practice Address - Street 2:
Practice Address - City:SAVOY
Practice Address - State:IL
Practice Address - Zip Code:61874-9510
Practice Address - Country:US
Practice Address - Phone:217-356-3400
Practice Address - Fax:217-866-0122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-28
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care