Provider Demographics
NPI:1417081241
Name:BAKER O & P ENTERPRISES
Entity Type:Organization
Organization Name:BAKER O & P ENTERPRISES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:KRATOHVIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-550-8760
Mailing Address - Street 1:451 WESTPARK WAY
Mailing Address - Street 2:SUITE 5
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76040-3703
Mailing Address - Country:US
Mailing Address - Phone:817-355-0001
Mailing Address - Fax:
Practice Address - Street 1:451 WESTPARK WAY
Practice Address - Street 2:SUITE 5
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76040-3703
Practice Address - Country:US
Practice Address - Phone:817-355-0001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101109335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX508508OtherBLUECROSSBLUESHIELD
TX4151040002Medicare ID - Type Unspecified