Provider Demographics
NPI:1124168778
Name:BAINBRIDGE ANESTHESIA ASSOCIATES PS
Entity type:Organization
Organization Name:BAINBRIDGE ANESTHESIA ASSOCIATES PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:REITER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-271-2846
Mailing Address - Street 1:6003 23RD DR W STE 100
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-1583
Mailing Address - Country:US
Mailing Address - Phone:425-407-1500
Mailing Address - Fax:
Practice Address - Street 1:9800 LEVIN RD NW
Practice Address - Street 2:SUITE 102
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-7856
Practice Address - Country:US
Practice Address - Phone:360-692-2728
Practice Address - Fax:425-609-0599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00023941207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA217857OtherL&I PROVIDER #
8864660OtherMEDICARE PTAN
WA1123843Medicaid