Provider Demographics
NPI:1669527891
Name:BAUM INCORPORATED
Entity type:Organization
Organization Name:BAUM INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BAUM
Authorized Official - Suffix:
Authorized Official - Credentials:PT, ATC, CLT
Authorized Official - Phone:702-877-2000
Mailing Address - Street 1:PO BOX 34797
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-4797
Mailing Address - Country:US
Mailing Address - Phone:702-877-2000
Mailing Address - Fax:702-877-2100
Practice Address - Street 1:7250 PEAK DR
Practice Address - Street 2:118
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-9027
Practice Address - Country:US
Practice Address - Phone:702-877-2000
Practice Address - Fax:702-877-2100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV003402781Medicaid
NV1942207899Medicare PIN
4682210001Medicare NSC
NV003402781Medicaid