Basic Information
| Provider Information | |||||||||
| NPI: | 1780679720 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BARIBEAULT | ||||||||
| FirstName: | RIC | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2411 FOUNTAIN VIEW DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770574832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7136204000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2411 FOUNTAIN VIEW DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770574832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7136204000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2005 | ||||||||
| LastUpdateDate: | 07/10/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 711764 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 163W00000X | RN531594 | PA | N | Nursing Service Providers | Registered Nurse | 367500000X | 053398 | PA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 1343154 | 01 | PA | KHP CENTRAL | OTHER | 2035826000 | 01 | PA | INDEP. BLUE CROSS | OTHER | 430070453 | 01 | PA | RAIL ROAD MEDICARE | OTHER | 75822 | 01 | PA | GEISINGER | OTHER | 8083UU | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER | 03221201 | 01 | PA | CAPITAL ADVANTAGE | OTHER | P00711697 | 01 | TX | RAILROAD MEDICARE | OTHER | 1343154 | 01 | PA | HIGHMARK | OTHER | 171672203 | 05 | TX | MEDICAID |