Provider Demographics
NPI:1992734743
Name:BAKER CLINIC, LLP
Entity type:Organization
Organization Name:BAKER CLINIC, LLP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MENZIE
Authorized Official - Last Name:MCKIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-523-4415
Mailing Address - Street 1:3175 POCAHONTAS RD
Mailing Address - Street 2:
Mailing Address - City:BAKER CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97814-1434
Mailing Address - Country:US
Mailing Address - Phone:541-523-4415
Mailing Address - Fax:541-523-2399
Practice Address - Street 1:3175 POCAHONTAS RD
Practice Address - Street 2:
Practice Address - City:BAKER CITY
Practice Address - State:OR
Practice Address - Zip Code:97814-1434
Practice Address - Country:US
Practice Address - Phone:541-523-4415
Practice Address - Fax:541-523-2399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR227616261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR227616Medicaid
OR0000WCGBCMedicare ID - Type UnspecifiedMEDICARE B NUMBER
OR383846Medicare Oscar/Certification