Provider Demographics
NPI:1134873318
Name:PURE HEALTH MEDICAL GROUP INC
Entity type:Organization
Organization Name:PURE HEALTH MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BAGGOT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-448-0213
Mailing Address - Street 1:866 N VERMONT AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-3587
Mailing Address - Country:US
Mailing Address - Phone:818-448-0213
Mailing Address - Fax:
Practice Address - Street 1:866 N VERMONT AVE STE 2
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-3587
Practice Address - Country:US
Practice Address - Phone:818-448-0213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty