Provider Demographics
NPI:1437552809
Name:BAY AREA EMERGENCY PHYSICIANS URGENT CARE LLC
Entity type:Organization
Organization Name:BAY AREA EMERGENCY PHYSICIANS URGENT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:POLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-274-7800
Mailing Address - Street 1:PO BOX 1728
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33757-1728
Mailing Address - Country:US
Mailing Address - Phone:727-532-1355
Mailing Address - Fax:727-266-4928
Practice Address - Street 1:13670 WALSINGHAM RD
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33774-3532
Practice Address - Country:US
Practice Address - Phone:727-532-1355
Practice Address - Fax:727-266-4928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-30
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty