1225177504 NPI number — NICHOLAS JOEL BAKER PA-C

Table of content: NICHOLAS JOEL BAKER PA-C (NPI 1225177504)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225177504 NPI number — NICHOLAS JOEL BAKER PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAKER
Provider First Name:
NICHOLAS
Provider Middle Name:
JOEL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225177504
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/17/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 NORTHRIDGE DR STE 118
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUCKHANNON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26201-8484
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-473-1440
Provider Business Mailing Address Fax Number:
304-473-1441

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4 NORTHRIDGE DR STE 118
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUCKHANNON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26201-8484
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-473-1440
Provider Business Practice Location Address Fax Number:
304-473-1441
Provider Enumeration Date:
02/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  01211 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: FQ1211 . This is a "HEALTH PLAN" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: #145072 . This is a "CARELINK" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 01211 . This is a "WV LICENSE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 001967359 . This is a "MT. STATE BC/BS PAY TO #" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: #001948536 . This is a "MT. STATE BC/BS SERVICE N" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 001804181 . This is a "MT. STATE BC/BS PAY TO #" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 55-0695143 . This is a "HEALTH PARTNERS NETWORK" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: P00670282 . This is a "RAILROAD MEDICARE PTAN" identifier . This identifiers is of the category "OTHER".




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