Healthcare Provider Details

I. General information

NPI: 1396807319
Provider Name (Legal Business Name): BAKER COMMUNITY HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 12/17/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 N 3RD ST
MACCLENNY FL
32063-2103
US

IV. Provider business mailing address

159 N 3RD ST
MACCLENNY FL
32063-2103
US

V. Phone/Fax

Practice location:
  • Phone: 904-259-3151
  • Fax: 904-259-3279
Mailing address:
  • Phone: 904-259-3151
  • Fax: 904-259-3279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY VARNADOE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 706-437-2683