Bayside Family Healthcare Clearwater, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

ME85120 Issued in FL

Legal business name

BAYSIDE FAMILY HEALTHCARE CLEARWATER, LLC

Practice address

107 N McMullen Booth Rd
Clearwater, FL 33759-4450

Phone

(727) 504-7073

Fax

(813) 200-3313

NPI assigned

Oct 6, 2010

Last updated

Oct 6, 2010By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Patrick E Hickey, ARNP

Title

MGRM

Phone

(727) 504-7073

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1286323200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1286323200000",
    "number": "1760791859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 N MCMULLEN BOOTH RD",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337594450",
            "telephone_number": "727-504-7073",
            "fax_number": "813-200-3313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 N MCMULLEN BOOTH RD",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337594450",
            "telephone_number": "727-504-7073",
            "fax_number": "813-200-3313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAYSIDE FAMILY HEALTHCARE CLEARWATER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-06",
        "last_updated": "2010-10-06",
        "status": "A",
        "authorized_official_last_name": "HICKEY",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "MGRM",
        "authorized_official_telephone_number": "727-504-7073",
        "authorized_official_credential": "ARNP"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME85120",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "274541100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Clearwater, FL
• Providers in Clearwater, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.