Provider Demographics
NPI:1942398078
Name:BAKER O & P ENTERPRISES INC
Entity Type:Organization
Organization Name:BAKER O & P ENTERPRISES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:BRADFORD
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-864-8783
Mailing Address - Street 1:810 LIPSCOMB ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3116
Mailing Address - Country:US
Mailing Address - Phone:817-332-7313
Mailing Address - Fax:
Practice Address - Street 1:810 LIPSCOMB ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3116
Practice Address - Country:US
Practice Address - Phone:817-332-7313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX530894OtherBCBS
TX82011OtherNORTHWOOD
TX145930701Medicaid
TX145930701Medicaid