Healthcare Provider Details

I. General information

NPI: 1437861432
Provider Name (Legal Business Name): PURE HEALTHCARE PROFESSIONAL MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2022
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 N SUNRISE AVE STE 1203
ROSEVILLE CA
95661-2932
US

IV. Provider business mailing address

4179 S RIVERBOAT RD STE 220
TAYLORSVILLE UT
84123-2986
US

V. Phone/Fax

Practice location:
  • Phone: 916-850-2559
  • Fax: 916-721-2456
Mailing address:
  • Phone: 801-921-6276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. JONATHAN M BAUGH
Title or Position: OWNER/DIRECTOR
Credential: D.O.
Phone: 435-922-1217