Organization
BASELINE DISTRIBUTING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RYAN DEAN PALMER (MANAGER)
(602) 908-2667
Entity
Organization
Contact information
Practice address
920 E HARWELL RD, PHOENIX, AZ 85042-6605
(602) 908-2667
Mailing address
920 E HARWELL RD, PHOENIX, AZ 85042-6605
(602) 908-2667
Taxonomy
Speciality
Code
Description
License number
State
2085U0001X
Diagnostic Ultrasound Physician
Primary
—
—
261QP2000X
Physical Therapy Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
625277
—
AZ
Enumeration date
04/18/2011
Last updated
09/09/2011
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