Provider Demographics
NPI:1669732707
Name:BAY AREA HEALTHCARE GROUP, LTD.
Entity type:Organization
Organization Name:BAY AREA HEALTHCARE GROUP, LTD.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:NICOSIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-761-1501
Mailing Address - Street 1:PO BOX 8991
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78468-8991
Mailing Address - Country:US
Mailing Address - Phone:361-761-1501
Mailing Address - Fax:361-857-5960
Practice Address - Street 1:3315 S ALAMEDA ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-1820
Practice Address - Country:US
Practice Address - Phone:361-761-1501
Practice Address - Fax:361-857-5960
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAY AREA HEALTHCARE GROUP. LTD.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-23
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
45T788Medicare Oscar/Certification