=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033906326
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NATHAN BAYLESS MSRS, RRA, RPA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/22/2025
-----------------------------------------------------
Last Update Date | 04/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | UPMC HAMOT 201 STATE STREET
-----------------------------------------------------
City | ERIE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16550-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-877-2072
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17238 STATE HIGHWAY 198
-----------------------------------------------------
City | SAEGERTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16433-3714
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-779-2593
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 247100000X
-----------------------------------------------------
Taxonomy Name | Radiologic Technologist
-----------------------------------------------------
License Number | 478624
-----------------------------------------------------
License Number State |
-----------------------------------------------------