Provider Demographics
NPI:1104029339
Name:MT. BAKER NEPHROLOGY ASSOCIATES INC PS
Entity Type:Organization
Organization Name:MT. BAKER NEPHROLOGY ASSOCIATES INC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RENAE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHULTHEIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-734-9233
Mailing Address - Street 1:410 BIRCHWOOD AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1783
Mailing Address - Country:US
Mailing Address - Phone:360-734-9233
Mailing Address - Fax:
Practice Address - Street 1:410 BIRCHWOOD AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1783
Practice Address - Country:US
Practice Address - Phone:360-734-9233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG001446800OtherMEDICARE IDENTIFICATION N
WA7021512Medicaid
WA1104029339OtherMEDICARE NPI