Provider Demographics
NPI:1588852115
Name:THEODORE BARTON
Entity Type:Organization
Organization Name:THEODORE BARTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:RATKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-262-2602
Mailing Address - Street 1:35670 KENAI SPUR HWY
Mailing Address - Street 2:SUITE 101A
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-7626
Mailing Address - Country:US
Mailing Address - Phone:907-262-2602
Mailing Address - Fax:907-262-5794
Practice Address - Street 1:35670 KENAI SPUR HWY
Practice Address - Street 2:SUITE 101A
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7626
Practice Address - Country:US
Practice Address - Phone:907-262-2602
Practice Address - Fax:907-262-5794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK5721367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNP5721Medicaid
AKMD1793Medicaid
AKQ31447Medicare UPIN
AKNP5721Medicaid
AK152144Medicare PIN
AKMD1793Medicaid