Provider Demographics
NPI:1528256724
Name:BAY AREA PROSTHETICS INC
Entity type:Organization
Organization Name:BAY AREA PROSTHETICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-992-7016
Mailing Address - Street 1:6901 S PADRE ISLAND DR
Mailing Address - Street 2:STE 103B
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-4929
Mailing Address - Country:US
Mailing Address - Phone:361-992-7016
Mailing Address - Fax:361-992-7369
Practice Address - Street 1:6901 S PADRE ISLAND DR
Practice Address - Street 2:STE 103B
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-4929
Practice Address - Country:US
Practice Address - Phone:361-992-7016
Practice Address - Fax:361-992-7369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX224335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX078936401Medicaid
TX0914920001Medicare NSC