1053590042 NPI number — BAKER FOOT SOLUTIONS CORP

Table of content: (NPI 1053590042)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053590042 NPI number — BAKER FOOT SOLUTIONS CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAKER FOOT SOLUTIONS CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053590042
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/16/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 330
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORTVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46040-0330
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-863-2556
Provider Business Mailing Address Fax Number:
317-203-0420

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1380 CHESTER BLVD
Provider Second Line Business Practice Location Address:
STE C
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47374-1907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-965-3668
Provider Business Practice Location Address Fax Number:
765-965-6530
Provider Enumeration Date:
10/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BAKER
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT DIRECTOR
Authorized Official Telephone Number:
317-863-2556

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  07000796A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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