Provider Demographics
NPI:1437861432
Name:PURE HEALTHCARE PROFESSIONAL MEDICAL SERVICES
Entity Type:Organization
Organization Name:PURE HEALTHCARE PROFESSIONAL MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:435-922-1217
Mailing Address - Street 1:4179 S RIVERBOAT RD STE 220
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84123-2986
Mailing Address - Country:US
Mailing Address - Phone:801-921-6276
Mailing Address - Fax:
Practice Address - Street 1:151 N SUNRISE AVE STE 1203
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2932
Practice Address - Country:US
Practice Address - Phone:916-850-2559
Practice Address - Fax:916-721-2456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-21
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty