Provider Demographics
NPI:1619173473
Name:BAY PINES VA HOSPITAL
Entity type:Organization
Organization Name:BAY PINES VA HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE EDUCATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MORELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-320-4375
Mailing Address - Street 1:1050 STARKEY RD
Mailing Address - Street 2:#2209
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-5457
Mailing Address - Country:US
Mailing Address - Phone:727-320-4375
Mailing Address - Fax:
Practice Address - Street 1:1050 STARKEY RD
Practice Address - Street 2:#2209
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-5457
Practice Address - Country:US
Practice Address - Phone:727-320-4375
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2238102313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility