1366585846 NPI number — NORTHWEST ALLIED ANESTHESIA INC

Table of content: ARIE BAKER MSW, LCSW (NPI 1003205451)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366585846 NPI number — NORTHWEST ALLIED ANESTHESIA INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHWEST ALLIED ANESTHESIA INC
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:
1366585846
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/14/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1275 SHILOH RD NW
Provider Second Line Business Mailing Address:
STE. 2120
Provider Business Mailing Address City Name:
KENNESAW
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30144-7175
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-255-1846
Provider Business Mailing Address Fax Number:
404-255-1831

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1275 SHILOH RD NW
Provider Second Line Business Practice Location Address:
STE. 2120
Provider Business Practice Location Address City Name:
KENNESAW
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30144-7175
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-255-1846
Provider Business Practice Location Address Fax Number:
404-255-1831
Provider Enumeration Date:
02/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HARRIS
Authorized Official First Name:
MARY ELLEN
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS ADMINISTRATOR
Authorized Official Telephone Number:
404-255-1846

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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