Provider Demographics
NPI:1205917051
Name:BAY WIDE DME COMPANY INC
Entity type:Organization
Organization Name:BAY WIDE DME COMPANY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CFO
Authorized Official - Prefix:
Authorized Official - First Name:TERESITA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GALANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-355-0940
Mailing Address - Street 1:60 EUREKA SQ
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-2653
Mailing Address - Country:US
Mailing Address - Phone:650-355-0940
Mailing Address - Fax:650-355-0911
Practice Address - Street 1:60 EUREKA SQ
Practice Address - Street 2:
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-2653
Practice Address - Country:US
Practice Address - Phone:650-355-0940
Practice Address - Fax:650-355-0911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17536332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME03276FMedicaid
CA5967220001Medicare NSC