Organization
BAY CITY ORTHOCARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE L DESARRO (ADMINISTRATIVE DIRECTOR)
(814) 452-4632
Entity
Organization
Contact information
Practice address
2313 PEACH ST, ERIE, PA 16502-2822
(814) 452-4632
(814) 452-4636
Mailing address
2313 PEACH ST, ERIE, PA 16502-2822
(814) 452-4632
(814) 452-4636
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
6000006121
PA
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001428224
BC HIGHMARK
PA
05
—
0019531980003
—
PA
Enumeration date
07/05/2005
Last updated
09/24/2012
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