Provider Demographics
NPI:1508021429
Name:S. BAKER & ASSOCIATES, LLC
Entity Type:Organization
Organization Name:S. BAKER & ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAO
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:W
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-768-3530
Mailing Address - Street 1:3318 HEALY DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1404
Mailing Address - Country:US
Mailing Address - Phone:336-768-3530
Mailing Address - Fax:336-768-1329
Practice Address - Street 1:3318 HEALY DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1404
Practice Address - Country:US
Practice Address - Phone:336-768-3530
Practice Address - Fax:336-768-1329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-21
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC34813202K00000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebologyGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2163150COtherMEDICARE INDIVIDUAL
NC8912745Medicaid
NC13217OtherBSBCNC
P00185717OtherRR MEDICARE
2163150COtherMEDICARE INDIVIDUAL