Organization
BAY PROSTHETIC CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GLENN E COTTRILL II C.P.O. (PRESIDENT/OWNER)
(850) 863-5959
Entity
Organization
Contact information
Practice address
930 MAR WALT DR, STE D, FORT WALTON BEACH, FL 32547-6706
(850) 863-5959
(850) 863-5977
Mailing address
930 MAR WALT DR, STE D, FORT WALTON BEACH, FL 32547-6706
(850) 863-5959
(850) 863-5977
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
POR31
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
M2541
BCBS PROVIDER NUMBER
FL
Enumeration date
06/17/2005
Last updated
08/22/2020
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