Provider Demographics
NPI:1083277206
Name:BAUM 5 STAR HEALTHCARE
Entity Type:Organization
Organization Name:BAUM 5 STAR HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MANIVANH
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUM
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:559-408-5533
Mailing Address - Street 1:560 W GRANGEVILLE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-2858
Mailing Address - Country:US
Mailing Address - Phone:559-408-5533
Mailing Address - Fax:800-827-1977
Practice Address - Street 1:560 W GRANGEVILLE BLVD STE A
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-2858
Practice Address - Country:US
Practice Address - Phone:559-408-5533
Practice Address - Fax:800-827-1977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-15
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty