1558806901 NPI number — CHRISTINE BAILES, LLC

Table of content: (NPI 1558806901)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558806901 NPI number — CHRISTINE BAILES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHRISTINE BAILES, LLC
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:
PINNACLE NEUROLOGY & INFUSION
Provider Other Organization Name Type Code:
3
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:
1558806901
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3505 E MERIDIAN PARK LOOP STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WASILLA
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99654-7242
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-864-0022
Provider Business Mailing Address Fax Number:
877-725-7371

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3505 E MERIDIAN PARK LOOP STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASILLA
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99654-7242
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-864-0022
Provider Business Practice Location Address Fax Number:
877-725-7371
Provider Enumeration Date:
12/21/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BAILES
Authorized Official First Name:
CHRISTINE
Authorized Official Middle Name:
OLGA
Authorized Official Title or Position:
ANP / OWNER
Authorized Official Telephone Number:
907-864-0022

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1660501 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1630807 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".