Basic Information
| Provider Information | |||||||||
| NPI: | 1194993949 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PARRISH MEDICAL CENTER | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | PATRICIA BAUMANN, DO | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7075 N US HIGHWAY 1 | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | PORT ST JOHN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329275216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3212686111 | ||||||||
| FaxNumber: | 3212680125 | ||||||||
| Practice Location | |||||||||
| Address1: | 7075 N US HIGHWAY 1 | ||||||||
| Address2: | |||||||||
| City: | PORT ST JOHN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329275216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3214331439 | ||||||||
| FaxNumber: | 3214332325 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2008 | ||||||||
| LastUpdateDate: | 02/14/2008 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CHILDS | ||||||||
| AuthorizedOfficialFirstName: | EMILY | ||||||||
| AuthorizedOfficialMiddleName: | ROSE ANNE | ||||||||
| AuthorizedOfficialTitleorPosition: | NETWORK COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 3212686111 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | PREMEIR ORTHOPEDICS GROUP | ||||||||
| AuthorizedOfficialNamePrefix: | MISS | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | OS7071 | FL | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.