Provider Demographics
NPI:1952520033
Name:BAYSIDE UROLOGY, PA
Entity Type:Organization
Organization Name:BAYSIDE UROLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILING & COLLECTIONS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:MORA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-881-9550
Mailing Address - Street 1:PO BOX 2848
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78403-2848
Mailing Address - Country:US
Mailing Address - Phone:361-881-9550
Mailing Address - Fax:361-881-8337
Practice Address - Street 1:2222 MORGAN AVE
Practice Address - Street 2:STE. #112
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78405-1948
Practice Address - Country:US
Practice Address - Phone:361-881-9550
Practice Address - Fax:361-881-8337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3782174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099538301Medicaid
TX0008176005OtherCIGNA
TX1900172OtherUNITED HEALTHCARE
TX1533350OtherUNITED MINE WORKERS
TX340014366OtherRAILROAD MEDICARE
TX5955010OtherAETNA
TX855163OtherFIRST HEALTH
TX0024CKOtherBLUE CROSS BLUE SHIELD
TX079579101Medicaid
TXP1619681OtherOXFORD
TX099538301Medicaid
TXP1619681OtherOXFORD
TX0008176005OtherCIGNA
TX1533350OtherUNITED MINE WORKERS