Basic Information
| Provider Information | |||||||||
| NPI: | 1609816214 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAISDEN | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | M. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2234 COLONIAL BLVD | ||||||||
| Address2: | ATTN: PAYER CONTRACTING & RELATIONS | ||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339071412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2399317342 | ||||||||
| FaxNumber: | 2399317385 | ||||||||
| Practice Location | |||||||||
| Address1: | 210 NEW HOPE RD | ||||||||
| Address2: | |||||||||
| City: | PRINCETON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 247402136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044251960 | ||||||||
| FaxNumber: | 3044259988 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 09/12/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | 0101237252 | VA | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0001X | 24688 | WV | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | P01001412 | 01 | WV | RAILROAD MEDICARE | OTHER | PAR | 01 | VA | UNITED HEALTH CARE/MAMSI | OTHER | 1609816214 | 05 | VA | MEDICAID | PAR | 01 | VA | TRICARE/CHAMPUS | OTHER | PAR | 01 | VA | VA HEALTH NETWORK | OTHER | 10058965 | 01 | VA | OPTIMA HEALTH PLAN | OTHER | PAR | 01 | VA | USA MANAGED CARE (EVMS HEALTH SERVICES) | OTHER | PAR | 01 | VA | CIGNA | OTHER | PAR | 01 | VA | CORVEL/CORCARE (EVMS HEALTH SERVICES) | OTHER | WV24688 | 01 | WV | THE HEALTH PLAN OF THE UPPER OHIO VALLEY | OTHER | 5914565 | 05 | NC | MEDICAID | P01060034 | 01 | WV | RAILROAD MEDICARE - WVRTSI | OTHER | 3810022555 | 05 | WV | MEDICAID | 403902 | 01 | VA | ANTHEM BC/BS EVMS HEALTH SERVICES | OTHER | PAR | 01 | VA | MULTIPLAN (EVMS HEALTH SERVICES) | OTHER | PAR | 01 | VA | FIRST HEALTH COMMERCIAL/COVENTRY HEALTH/SOUTHERN HEALTH | OTHER | 403901 | 01 | VA | ANTHEM BC/BS EVMS HEALTH SERVICES | OTHER | 9303191 | 01 | WV | AETNA | OTHER | PAR | 01 | VA | VA PREMIER HEALTH (EVMS HEALTH SERVICES) | OTHER | PAR | 01 | VA | AETNA | OTHER |