Provider Demographics
NPI:1588620421
Name:ERIC BAUMANN MD, PC
Entity Type:Organization
Organization Name:ERIC BAUMANN MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANACAYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-717-0788
Mailing Address - Street 1:2100 CENTERPOINTE WEST DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-8487
Mailing Address - Country:US
Mailing Address - Phone:928-717-0788
Mailing Address - Fax:928-717-0748
Practice Address - Street 1:2100 CENTERPOINTE WEST DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-8487
Practice Address - Country:US
Practice Address - Phone:928-717-0788
Practice Address - Fax:928-717-0748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ340592081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ56857Medicare UPIN
AZ105250Medicare ID - Type UnspecifiedINDIVIDUAL ID #
AZ105251Medicare ID - Type UnspecifiedGROUP ID #