Provider Demographics
NPI:1316994544
Name:BAY AREA GYNECOLOGICAL ONCOLOGY, PA
Entity type:Organization
Organization Name:BAY AREA GYNECOLOGICAL ONCOLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-848-3944
Mailing Address - Street 1:5622 MARINE PKWY
Mailing Address - Street 2:# 18, COLONIAL MEDICAL CTR.
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-4333
Mailing Address - Country:US
Mailing Address - Phone:727-848-3944
Mailing Address - Fax:
Practice Address - Street 1:5622 MARINE PKWY
Practice Address - Street 2:# 18, COLONIAL MEDICAL CTR.
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-4333
Practice Address - Country:US
Practice Address - Phone:727-848-3944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00048941Medicare ID - Type UnspecifiedRR MEDICARE (PGBA)