1619069523 NPI number — BAKER EAR NOSE & THROAT ASSOCIATES PLC

Table of content: (NPI 1619069523)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619069523 NPI number — BAKER EAR NOSE & THROAT ASSOCIATES PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAKER EAR NOSE & THROAT ASSOCIATES PLC
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:
1619069523
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/31/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4175 N EUCLID
Provider Second Line Business Mailing Address:
SUITE 10
Provider Business Mailing Address City Name:
BAY CITY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48706
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-684-4400
Provider Business Mailing Address Fax Number:
989-684-0560

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4175 N EUCLID
Provider Second Line Business Practice Location Address:
SUITE 10
Provider Business Practice Location Address City Name:
BAY CITY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-684-4400
Provider Business Practice Location Address Fax Number:
989-684-0560
Provider Enumeration Date:
09/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BAKER
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
989-684-4400

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , with the licence number:  4301053017 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3043790 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0400910811 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0400923042 . This is a "HEALTHPLUS PROVIDER ID" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1619069523 . This is a "GROUP NPI NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1285625210 . This is a "INDIVIDUAL NPI NUMBER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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