1548291016 NPI number — BAKER FOOT SOLUTIONS CORP

Table of content: (NPI 1548291016)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548291016 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:
EAST FOOT AND ANKLE CENTER
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:
1548291016
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/26/2019
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:
10122 E 10TH ST STE 230
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46229-2664
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-898-6624
Provider Business Practice Location Address Fax Number:
317-898-6636
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , 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)

  • Identifier: DD2888 . This is a "RR MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000360213 . This is a "BLUE CROSS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200513150A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com