Provider Demographics
NPI:1447691506
Name:BAYSIDE REGENERATIVE MEDICINE
Entity type:Organization
Organization Name:BAYSIDE REGENERATIVE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:KALMBACHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-990-8388
Mailing Address - Street 1:8335 GAYFER ROAD EXT
Mailing Address - Street 2:SUITE F
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-3051
Mailing Address - Country:US
Mailing Address - Phone:251-990-8388
Mailing Address - Fax:251-990-8389
Practice Address - Street 1:8335 GAYFER ROAD EXT
Practice Address - Street 2:SUITE F
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-3051
Practice Address - Country:US
Practice Address - Phone:251-990-8388
Practice Address - Fax:251-990-8389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10302261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center