Healthcare Provider Details

I. General information

NPI: 1912148446
Provider Name (Legal Business Name): BAKS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2009
Last Update Date: 03/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 N RIDGE RD SUITE D
WICHITA KS
67205-1053
US

IV. Provider business mailing address

2230 N RIDGE RD SUITE D
WICHITA KS
67205-1053
US

V. Phone/Fax

Practice location:
  • Phone: 316-425-7717
  • Fax: 316-260-3317
Mailing address:
  • Phone: 316-425-7717
  • Fax: 316-260-3317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ANN DEXTER
Title or Position: VICE PRESIDENT
Credential:
Phone: 316-425-7717