Healthcare Provider Details

I. General information

NPI: 1245315738
Provider Name (Legal Business Name): BAKER MEDICAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 05/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2097 HIGHWAY 65 S
CLINTON AR
72031-6737
US

IV. Provider business mailing address

1014 HARKRIDER ST SUITE 500
CONWAY AR
72032-4404
US

V. Phone/Fax

Practice location:
  • Phone: 501-745-3040
  • Fax:
Mailing address:
  • Phone: 501-932-0404
  • Fax: 501-932-0387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License NumberNG00612
License Number StateAR

VIII. Authorized Official

Name: DR. JAMES R BAKER
Title or Position: OWNER
Credential: PHARM. D.
Phone: 501-932-0404