1033202288 NPI number — DR. WILLIAM T BAKER MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033202288 NPI number — DR. WILLIAM T BAKER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAKER
Provider First Name:
WILLIAM
Provider Middle Name:
T
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1033202288
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4601 ABERCORNE TER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40241-6145
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-897-3241
Provider Business Mailing Address Fax Number:
502-969-3799

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 E CHESTNUT ST DEPT 3R
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40202-1831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-629-7181
Provider Business Practice Location Address Fax Number:
502-629-6957
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  21175 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100004200 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50022679 . This is a "PASSPORT - WS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000023035R . This is a "HUMANA - WS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 103689 . This is a "SIHO - WS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 00533116 . This is a "MEDICARE KY - WS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1069145 . This is a "PASSPORT" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 3698416000 . This is a "PASSPORT ADVTG - WS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 64211758 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1033202288 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000605980 . This is a "ANTHEM - WS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 2537857 . This is a "CIGNA - WS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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