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BAY SIDE MEDICAL CENTER LLC NPI 1114236940


NPI Information

NPI: 1114236940
Provider Name: BAY SIDE MEDICAL CENTER LLC

Other Name: LEO B. DALTON, D.O.

Classification: Family Medicine - 207Q00000X
Entity Type: Organization
Address:
9545 BAY PINES BLVD
ST PETERSBURG, FL
ZIP 33708
Phone: (727) 393-8715
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BAY SIDE MEDICAL CENTER LLC is a family medicine in St Petersburg, FL. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. BAY SIDE MEDICAL CENTER LLC NPI is 1114236940. The provider is registered as an organization entity type and is a single specialty group.
The provider Other Name Is Leo B. Dalton, D.o..

The provider's business location address is:

9545 BAY PINES BLVD
ST PETERSBURG, FL
ZIP 33708-754
Phone: (727) 393-8715
Fax: (727) 393-8717

The provider's authorized official is Leo Bernard Dalton .
The authorized official title is Owner and has the following contact phone number (727) 393-8715.

The enumeration date for this NPI number is 9/28/2010 and was last updated on 9/28/2010.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207Q00000XFamily MedicineOS3212FLORIDAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
181796MEDICARE PINFLORIDA
2E34354MEDICARE UPINFLORIDA
3OS3212OTHERFLORIDASTATE LICENSE NUMBER
4040070000MEDICAIDFLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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