Provider Demographics
NPI:1104926401
Name:BAKER COUNTY MEDICAL SERVICES INC
Entity type:Organization
Organization Name:BAKER COUNTY MEDICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:VARNADOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-259-3151
Mailing Address - Street 1:PO BOX 484
Mailing Address - Street 2:
Mailing Address - City:MACCLENNY
Mailing Address - State:FL
Mailing Address - Zip Code:32063-0484
Mailing Address - Country:US
Mailing Address - Phone:904-259-3151
Mailing Address - Fax:904-259-3279
Practice Address - Street 1:159 N 3RD ST
Practice Address - Street 2:
Practice Address - City:MACCLENNY
Practice Address - State:FL
Practice Address - Zip Code:32063-2103
Practice Address - Country:US
Practice Address - Phone:904-259-3151
Practice Address - Fax:904-259-3279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF1581096314000000X
FLPH137093336C0003X
FLPH90393336I0012X
FLPH137103336I0012X
FL4152282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010004800Medicaid
FL266702900Medicaid
FL021105200Medicaid
FL022384100Medicaid
FL266702900Medicaid
FL022384100Medicaid
FL100134Medicare Oscar/Certification