Healthcare Provider Details

I. General information

NPI: 1104926401
Provider Name (Legal Business Name): BAKER COUNTY MEDICAL SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 06/21/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 N 3RD ST
MACCLENNY FL
32063-2103
US

IV. Provider business mailing address

PO BOX 484
MACCLENNY FL
32063-0484
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 Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF1581096
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH13709
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License NumberPH9039
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License NumberPH13710
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number4152
License Number StateFL

VIII. Authorized Official

Name: MRS. TIFFANY VARNADOE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 904-259-3151