1346261492 NPI number — RALPH LAMONT BAKER

Table of content: (NPI 1346261492)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346261492 NPI number — RALPH LAMONT BAKER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RALPH LAMONT BAKER
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:
RALPH BAKER'S SHOES
Provider Other Organization Name Type Code:
3
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:
1346261492
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
428 N MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALISBURY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28144-4349
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-636-1850
Provider Business Mailing Address Fax Number:
704-637-7120

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
428 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALISBURY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28144-4349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-636-1850
Provider Business Practice Location Address Fax Number:
704-637-7120
Provider Enumeration Date:
07/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BAKER
Authorized Official First Name:
RALPH
Authorized Official Middle Name:
LAMONT
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
704-636-1850

Provider Taxonomy Codes

  • Taxonomy code: 332BC3200X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 205141300 . This is a "US DEPT OF LABOR" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 7967497 . This is a "AETNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8209567 . This is a "MEDICARE COMPLETE UHC HMO" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 0425V . This is a "BCBS OF NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 7702031 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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