1124168778 NPI number — BAINBRIDGE ANESTHESIA ASSOCIATES PS

Table of content: (NPI 1124168778)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124168778 NPI number — BAINBRIDGE ANESTHESIA ASSOCIATES PS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAINBRIDGE ANESTHESIA ASSOCIATES PS
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:
1124168778
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/09/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6003 23RD DR W STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVERETT
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98203-1583
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-407-1500
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9800 LEVIN RD NW
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
SILVERDALE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98383-7856
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-692-2728
Provider Business Practice Location Address Fax Number:
425-609-0599
Provider Enumeration Date:
02/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
REITER
Authorized Official First Name:
BLAKE
Authorized Official Middle Name:
EDWARD
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
360-271-2846

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  MD00023941 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 217857 . This is a "L&I PROVIDER #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8864660 . This is a "MEDICARE PTAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1123843 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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