Provider Demographics
NPI:1366478562
Name:BAKER MEDICAL, INC.
Entity Type:Organization
Organization Name:BAKER MEDICAL, INC.
Other - Org Name:BAKER MEDICAL, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:501-932-0404
Mailing Address - Street 1:1014 HARKRIDER ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-4404
Mailing Address - Country:US
Mailing Address - Phone:501-932-0404
Mailing Address - Fax:501-764-0505
Practice Address - Street 1:1014 HARKRIDER ST
Practice Address - Street 2:SUITE 500
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-4404
Practice Address - Country:US
Practice Address - Phone:501-932-0404
Practice Address - Fax:501-764-0505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARMG00515332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR148671716Medicaid
AR49919OtherARKANSAS BLUE CROSS
ARC08480131OtherEDI SUBMITTER ID
AR4622870001Medicare NSC