Healthcare Provider Details

I. General information

NPI: 1508021429
Provider Name (Legal Business Name): S. BAKER & ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2008
Last Update Date: 09/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3318 HEALY DR
WINSTON SALEM NC
27103-1404
US

IV. Provider business mailing address

3318 HEALY DR
WINSTON SALEM NC
27103-1404
US

V. Phone/Fax

Practice location:
  • Phone: 336-768-3530
  • Fax: 336-768-1329
Mailing address:
  • Phone: 336-768-3530
  • Fax: 336-768-1329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number34813
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number34813
License Number StateNC

VIII. Authorized Official

Name: DR. SCOTT W. BAKER
Title or Position: CAO
Credential: MD
Phone: 336-768-3530