1326330887 NPI number — BIRON D. BAKER FAMILY MEDICINE, P.C.

Table of content: (NPI 1326330887)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326330887 NPI number — BIRON D. BAKER FAMILY MEDICINE, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BIRON D. BAKER FAMILY MEDICINE, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1326330887
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/28/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4401 COLEMAN ST STE 107
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BISMARCK
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58503-1371
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-751-4340
Provider Business Mailing Address Fax Number:
701-751-4332

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4401 COLEMAN ST STE 107
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BISMARCK
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58503-1371
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-751-4390
Provider Business Practice Location Address Fax Number:
701-751-4332
Provider Enumeration Date:
05/03/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PIATZ
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
701-751-4340

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  7534 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X , with the licence number: R29280 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 15723 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".