1366995029 NPI number — BAKER FOOT SOLUTIONS CORP

Table of content: (NPI 1366995029)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366995029 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:
6
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:
1366995029
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2017
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:
7330 E 82ND ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46256-1465
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-712-3708
Provider Business Practice Location Address Fax Number:
317-712-3798
Provider Enumeration Date:
07/29/2016

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: 261QP1100X , with the licence number:  07001159A , 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".




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