Healthcare Provider Details

I. General information

NPI: 1124168778
Provider Name (Legal Business Name): BAINBRIDGE ANESTHESIA ASSOCIATES PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 11/09/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9800 LEVIN RD NW SUITE 102
SILVERDALE WA
98383-7856
US

IV. Provider business mailing address

6003 23RD DR W STE 100
EVERETT WA
98203-1583
US

V. Phone/Fax

Practice location:
  • Phone: 360-692-2728
  • Fax: 425-609-0599
Mailing address:
  • Phone: 425-407-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD00023941
License Number StateWA

VIII. Authorized Official

Name: DR. BLAKE EDWARD REITER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 360-271-2846