MEDICARE: BAKS 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	251F00000X	Home Infusion Agency
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1912148446
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAKS INC.

Provider Business Mailing Address
First Line	:	2230 N RIDGE RD
Second Line	:	SUITE D
City	:	WICHITA
State	:	KS
Zip	:	67205-1053
Country	:	US
Telephone Number	:	316-425-7717
Fax Number	:	316-260-3317

Provider Business Practice Location Address
First Line	:	2230 N RIDGE RD
Second Line	:	SUITE D
City	:	WICHITA
State	:	KS
Zip	:	67205-1053
Country	:	US
Telephone Number	:	316-425-7717
Fax Number	:	316-260-3317

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	ANN DEXTER
Credential	:
Telephone Number	:	316-425-7717

Provider Enumeration Date	:	03/12/2009
Last Update Date	:	03/12/2009

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