Provider Demographics
NPI:1104920826
Name:BAY AREA PRIMARY CARE ASSOCIATES
Entity type:Organization
Organization Name:BAY AREA PRIMARY CARE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PALLAVI
Authorized Official - Middle Name:K
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-239-3262
Mailing Address - Street 1:PO BOX 152534
Mailing Address - Street 2:BAY AREA PRIMARY CARE ASSOC. INC
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33684-2534
Mailing Address - Country:US
Mailing Address - Phone:813-239-3262
Mailing Address - Fax:813-237-6941
Practice Address - Street 1:2123 W. DR MLK BLVD, SUITE 203
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6545
Practice Address - Country:US
Practice Address - Phone:813-870-1600
Practice Address - Fax:813-673-8777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
FLME0039612208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL066613100Medicaid
FL77135Medicare PIN
30449AMedicare UPIN