Provider Demographics
NPI:1851628333
Name:MT BAKER PAIN CLINIC, P.S.
Entity Type:Organization
Organization Name:MT BAKER PAIN CLINIC, P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CERAR
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CRRN, CASC
Authorized Official - Phone:360-752-0518
Mailing Address - Street 1:4029 NORTHWEST AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-9077
Mailing Address - Country:US
Mailing Address - Phone:360-752-0518
Mailing Address - Fax:360-676-2896
Practice Address - Street 1:4029 NORTHWEST AVE STE 301
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-9077
Practice Address - Country:US
Practice Address - Phone:360-752-0518
Practice Address - Fax:360-676-2896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602939596261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain