MEDICARE: BAIDEN GROUP INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336M0003X	Managed Care Organization Pharmacy
3	3336C0003X	Community/Retail Pharmacy	PHY49781	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2114887	OTHER		PK

General Provider Information

NPI Number	:	1689610784
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAIDEN GROUP INC

Provider Business Mailing Address
First Line	:	9160 CALIFORNIA CITY BLVD
Second Line	:
City	:	CALIFORNIA CITY
State	:	CA
Zip	:	93505-2820
Country	:	US
Telephone Number	:	760-373-9279
Fax Number	:	760-373-5271

Provider Business Practice Location Address
First Line	:	9160 CALIFORNIA CITY BLVD
Second Line	:
City	:	CALIFORNIA CITY
State	:	CA
Zip	:	93505-2820
Country	:	US
Telephone Number	:	760-373-9279
Fax Number	:	760-373-5271

Authorized Official
Title or Position	:	OWNER
Name	:	AMMA AMIHYIA
Credential	:
Telephone Number	:	760-373-9279

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	04/01/2016

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Directions to “BAIDEN GROUP INC ” Practice Location

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