Organization
BAY PEDIATRIC CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LOIS MARIE MONVILLE (OFFICE MANAGER)
(989) 892-2517
Entity
Organization
Contact information
Practice address
2110 16TH ST, BAY CITY, MI 48708-7609
(989) 892-2517
(989) 892-4860
Mailing address
2110 16TH ST, BAY CITY, MI 48708-7609
(989) 892-2517
(989) 892-4860
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
350Z96028
BLUE CROSS
MI
Enumeration date
12/19/2006
Last updated
08/22/2020
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