1649227059 NPI number — PAUL BACH PHD

Table of content: PAUL BACH PHD (NPI 1649227059)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649227059 NPI number — PAUL BACH PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BACH
Provider First Name:
PAUL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHD
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:
1649227059
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/23/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
87 SCHOOLHOUSE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLOOMSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17815-9569
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-317-2694
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 N ORANGE ST
Provider Second Line Business Practice Location Address:
THIRD FLOOR
Provider Business Practice Location Address City Name:
MISSOULA
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59802-2998
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-327-3350
Provider Business Practice Location Address Fax Number:
406-327-3396
Provider Enumeration Date:
05/30/2006

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: 103TC0700X , with the licence number:  PS016937 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103G00000X , with the licence number: 136 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0490569 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".