Provider Demographics
NPI:1023033859
Name:JOHN V. BAKA M.D.P.A
Entity Type:Organization
Organization Name:JOHN V. BAKA M.D.P.A
Other - Org Name:BENTON WOMEN'S CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:BAKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-778-1000
Mailing Address - Street 1:PO BOX 604
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72018-0604
Mailing Address - Country:US
Mailing Address - Phone:501-778-1000
Mailing Address - Fax:501-778-1010
Practice Address - Street 1:1220 MILITARY RD
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-2908
Practice Address - Country:US
Practice Address - Phone:501-778-1000
Practice Address - Fax:501-778-1010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE0792174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR16839000000OtherQC
AR137424002Medicaid
AR5K157OtherBCBS
AR5K157Medicare ID - Type Unspecified
AR137424002Medicaid