# BASELINE DISTRIBUTING, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1578853065
- **Authorized official:** MR. RYAN DEAN PALMER (MANAGER)
- **Authorized official phone:** (602) 908-2667

## Contact information

- **Practice address:** 920 E HARWELL RD, PHOENIX, AZ 85042-6605
- **Practice address phone:** (602) 908-2667
- **Mailing address:** 920 E HARWELL RD, PHOENIX, AZ 85042-6605
- **Mailing address phone:** (602) 908-2667

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2085U0001X | Diagnostic Ultrasound Physician | — | NULL | Yes |
| 2085U0001X | Diagnostic Ultrasound Physician | — | — | Yes |
| 261QP2000X | Physical Therapy Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 04/18/2011
- **Last updated:** 09/09/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 625277 | — | AZ |