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Mallory Camille Baker

Internal Medicine

Allopathic & Osteopathic Physicians

550 S Jackson St, Louisville, KY 40202-1622

PECOS Enrollment

This provider is enrolled in PECOS as MALLORY BAKER.

Based on the most recent information from CMS, provider Mallory Camille Baker is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 3 days ago.

Profile Details

Provider ID
1518209089
Provider Type
Individual
Full Name
Baker, Mallory Camille
Title
Mrs.

Gender
Female
Sole Proprietor
No
Enumeration Date
3/22/2013
Last Updated
5/22/2017

Contact Information

Practice Location

550 S Jackson St, Louisville, KY 40202-1622

(502) 852-4277

Unlisted Fax

Mailing Location

741 President Pl, Ste 200, Smyrna, TN 37167-6809

(615) 369-9899

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 207R00000X Primary	Description Internal Medicine Allopathic & Osteopathic Physicians	License 55808 Tennessee
Code 208000000X	Description Pediatrics Allopathic & Osteopathic Physicians	License 55808 Tennessee

Mallory Camille Baker

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

University Of Louisville Physicians, Inc.

Mcmullin, Malik

Spindel, Jeffrey

Tobias, Derrick Edward

Azabache Orrillo, Hilda Evelyn

Adami, Megan D

Elrod, Jeffrey Mark

Mccubbin, Jason P

Gardon, Mark Anthony

Davis, Paul