Provider Demographics
NPI:1447322615
Name:BABA HEALTHCARE, INC.
Entity type:Organization
Organization Name:BABA HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEETHA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIYANKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-367-7822
Mailing Address - Street 1:948 S WICKHAM RD STE 101
Mailing Address - Street 2:
Mailing Address - City:WEST MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-1647
Mailing Address - Country:US
Mailing Address - Phone:321-956-7370
Mailing Address - Fax:321-956-7873
Practice Address - Street 1:948 S WICKHAM RD STE 101
Practice Address - Street 2:
Practice Address - City:WEST MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-1647
Practice Address - Country:US
Practice Address - Phone:321-956-7370
Practice Address - Fax:321-956-7873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL49252OtherBCBS
FL257471300Medicaid
FL49252SMedicare ID - Type Unspecified