| Bayside Medical Practice Of Vilano Beach Llc | |
|
101 Yacht Club Dr St Augustine FL 32084-2196 | |
| (904) 217-4550 | |
| Not Available |
| Full Name | Bayside Medical Practice Of Vilano Beach Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 101 Yacht Club Dr, St Augustine, Florida |
| Authorized Official Name and Position | Tammy Rowland Dye (PRESIDENT) |
| Authorized Official Contact | 3059160183 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bayside Medical Practice Of Vilano Beach Llc 101 Yacht Club Dr Saint Augustine FL 32084-2196 Ph: (904) 217-4550 | Bayside Medical Practice Of Vilano Beach Llc 101 Yacht Club Dr St Augustine FL 32084-2196 Ph: (904) 217-4550 |
| NPI Number | 1760168330 |
|---|---|
| Provider Enumeration Date | 06/27/2023 |
| Last Update Date | 02/05/2024 |
| Medicare PECOS PAC ID | 7911361936 |
|---|---|
| Medicare Enrollment ID | O20230909000231 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760168330 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Tammy Rowland Dye |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871854638 PECOS PAC ID: 8820452840 Enrollment ID: I20230909000236 |
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