Healthcare Provider Details

I. General information

NPI: 1346261492
Provider Name (Legal Business Name): RALPH LAMONT BAKER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 08/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 N MAIN ST
SALISBURY NC
28144-4349
US

IV. Provider business mailing address

428 N MAIN ST
SALISBURY NC
28144-4349
US

V. Phone/Fax

Practice location:
  • Phone: 704-636-1850
  • Fax: 704-637-7120
Mailing address:
  • Phone: 704-636-1850
  • Fax: 704-637-7120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. RALPH LAMONT BAKER SR.
Title or Position: OWNER
Credential:
Phone: 704-636-1850