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General NPI Number Information
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NPI Number | 1053301473
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Entity Type | Organization
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Legal Business Name | BAKER AMBULATORY SURGERY CENTER
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Dates
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Enumeration Date | 10/26/2005
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Last Update Date | 10/05/2011
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Provider Practice Location Address
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Address Line | 810 MERRIMAN ST
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City | CONWAY
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State | AR
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Zip | 72032-4436
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Country | US
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Telephone | 501-329-3937
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Fax | 501-730-0466
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Provider Business Mailing Address
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Address Line | 810 MERRIMAN ST
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City | CONWAY
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State | AR
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Zip | 72032-4436
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Country | US
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Telephone | 501-329-3937
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Fax | 501-932-7663
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Authorized Official
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Title or Position | OWNER/ OPHTHALMOLOGIST
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Name | DAVID LITTLETON BAKER JR.
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Credential | MD
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Telephone | 501-329-3937
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | AR3919
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License Number State | AR
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