Provider Demographics
NPI:1114977857
Name:MOUNT BAKER KIDNEY CENTER, INCORPORATED
Entity Type:Organization
Organization Name:MOUNT BAKER KIDNEY CENTER, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:LEHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MHA, CPA
Authorized Official - Phone:800-525-9059
Mailing Address - Street 1:410 BIRCHWOOD AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1783
Mailing Address - Country:US
Mailing Address - Phone:360-734-4243
Mailing Address - Fax:360-715-9858
Practice Address - Street 1:410 BIRCHWOOD AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1783
Practice Address - Country:US
Practice Address - Phone:360-734-4243
Practice Address - Fax:360-715-9858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2012-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3999000Medicaid
WA502501Medicare ID - Type UnspecifiedESRD