1033392238 NPI number — MR. BARNABAS GRAYDON KEISTER BACHELORS DEGREE

Table of content: MR. BARNABAS GRAYDON KEISTER BACHELORS DEGREE (NPI 1033392238)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033392238 NPI number — MR. BARNABAS GRAYDON KEISTER BACHELORS DEGREE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KEISTER
Provider First Name:
BARNABAS
Provider Middle Name:
GRAYDON
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
BACHELORS DEGREE
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:
1033392238
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3300 GLENWOOD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EUREKA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95501-3463
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-444-8293
Provider Business Mailing Address Fax Number:
707-444-8298

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3300 GLENWOOD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EUREKA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95501-3463
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-444-8293
Provider Business Practice Location Address Fax Number:
707-444-8298
Provider Enumeration Date:
12/11/2007

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: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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