Provider Demographics
NPI:1376780544
Name:BAIN-BAULING COMPANY PLLC
Entity Type:Organization
Organization Name:BAIN-BAULING COMPANY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAULUS
Authorized Official - Middle Name:
Authorized Official - Last Name:BAULING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-482-2866
Mailing Address - Street 1:PO BOX 273242
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80527-3242
Mailing Address - Country:US
Mailing Address - Phone:970-482-2866
Mailing Address - Fax:970-472-0114
Practice Address - Street 1:2500 ROCKY MOUNTAIN AVE BLDG SUITE350
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-9004
Practice Address - Country:US
Practice Address - Phone:970-482-2866
Practice Address - Fax:970-472-0114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-09
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO25951208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO23526564Medicaid
CO23526564Medicaid