1639112444 NPI number — JORDON BAKER ACQUISITIONS, INC.

Table of content: (NPI 1639112444)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639112444 NPI number — JORDON BAKER ACQUISITIONS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JORDON BAKER ACQUISITIONS, INC.
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:
1639112444
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8251 US HIGHWAY 19E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROAN MOUNTAIN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37687
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-772-3591
Provider Business Mailing Address Fax Number:
423-772-4596

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8251 US HIGHWAY 19E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROAN MOUNTAIN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37687
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-772-3591
Provider Business Practice Location Address Fax Number:
423-772-4596
Provider Enumeration Date:
06/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BAKER
Authorized Official First Name:
JORDON
Authorized Official Middle Name:
THOMAS
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
423-772-3591

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: Q019339 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com