Provider Demographics
NPI:1346261492
Name:RALPH LAMONT BAKER
Entity Type:Organization
Organization Name:RALPH LAMONT BAKER
Other - Org Name:RALPH BAKER'S SHOES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:LAMONT
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:704-636-1850
Mailing Address - Street 1:428 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-4349
Mailing Address - Country:US
Mailing Address - Phone:704-636-1850
Mailing Address - Fax:704-637-7120
Practice Address - Street 1:428 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-4349
Practice Address - Country:US
Practice Address - Phone:704-636-1850
Practice Address - Fax:704-637-7120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC332BC3200X
335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC205141300OtherUS DEPT OF LABOR
NC7967497OtherAETNA
NC8209567OtherMEDICARE COMPLETE UHC HMO
NC0425VOtherBCBS OF NC
NC7702031Medicaid
NC205141300OtherUS DEPT OF LABOR