MEDICARE: K. R. BAKER ENTERPRISES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1144564345
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	K. R. BAKER ENTERPRISES, INC.

Provider Business Mailing Address
First Line	:	4321 KINGWOOD DR # 143
Second Line	:
City	:	KINGWOOD
State	:	TX
Zip	:	77339-3700
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4321 KINGWOOD DR # 143
Second Line	:
City	:	KINGWOOD
State	:	TX
Zip	:	77339-3700
Country	:	US
Telephone Number	:	832-814-3987
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KEVIN BAKER
Credential	:
Telephone Number	:	832-814-3987

Provider Enumeration Date	:	11/12/2012
Last Update Date	:	11/12/2012

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