Provider Demographics
NPI:1053301473
Name:BAKER AMBULATORY SURGERY CENTER
Entity Type:Organization
Organization Name:BAKER AMBULATORY SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ OPHTHALMOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LITTLETON
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:501-329-3937
Mailing Address - Street 1:810 MERRIMAN ST
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-4436
Mailing Address - Country:US
Mailing Address - Phone:501-329-3937
Mailing Address - Fax:501-932-7663
Practice Address - Street 1:810 MERRIMAN ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-4436
Practice Address - Country:US
Practice Address - Phone:501-329-3937
Practice Address - Fax:501-730-0466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-26
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR3919261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR142854128Medicaid
AR142854128Medicaid