Basic Information
| Provider Information | |||||||||
| NPI: | 1699721589 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BAY HOSPITAL, INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | HCA FLORIDA GULF COAST HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 449 W 23RD ST | ||||||||
| Address2: | |||||||||
| City: | PANAMA CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 324054507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8507698341 | ||||||||
| FaxNumber: | 8507477107 | ||||||||
| Practice Location | |||||||||
| Address1: | 449 W 23RD ST | ||||||||
| Address2: | |||||||||
| City: | PANAMA CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 324054507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8507698341 | ||||||||
| FaxNumber: | 8507477107 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2006 | ||||||||
| LastUpdateDate: | 03/30/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | GOODPASTER | ||||||||
| AuthorizedOfficialFirstName: | AMBER | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 8507477140 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 03/30/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 01554012 | 05 | NY | MEDICAID | 100242 | 05 | RI | MEDICAID | 110262105 | 05 | AR | MEDICAID | 11761700 | 05 | FL | MEDICAID | 20001388 | 05 | NH | MEDICAID | 437 | 01 | BLUE CROSS | OTHER | 44621 | 01 | AMERIGROUP | OTHER | 6881203 | 05 | NJ | MEDICAID | XHSP32728 | 05 | CA | MEDICAID | 100041970A | 05 | IN | MEDICAID | 1009729 | 05 | MA | MEDICAID | 541223400 | 05 | MN | MEDICAID | B2844 | 05 | NM | MEDICAID | HOS0242N | 05 | AL | MEDICAID | 1002422 | 05 | VA | MEDICAID | 107876801 | 05 | TX | MEDICAID | 0100242 | 05 | TN | MEDICAID | 1524390 | 05 | PA | MEDICAID | 95018529 | 05 | CO | MEDICAID | 0540765 | 05 | IA | MEDICAID | 10702A | 05 | SC | MEDICAID | 1743020 | 05 | LA | MEDICAID | HS2IPFL | 05 | AK | MEDICAID | 00220298 | 05 | MS | MEDICAID | 01290907 | 05 | KY | MEDICAID | 110774700 | 05 | WY | MEDICAID | 209335900 | 05 | MD | MEDICAID | 220378 | 01 | AVMED | OTHER | 81518600 | 05 | WI | MEDICAID | 0171974000 | 05 | WV | MEDICAID | 0569648 | 05 | OH | MEDICAID | 3017241 | 05 | WA | MEDICAID |