Healthcare Provider Details

I. General information

NPI: 1053614461
Provider Name (Legal Business Name): BAYBURY MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2010
Last Update Date: 12/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 LANTRIP RD
SHERWOOD AR
72120-4161
US

IV. Provider business mailing address

1051 LANTRIP RD
SHERWOOD AR
72120-4161
US

V. Phone/Fax

Practice location:
  • Phone: 501-833-0087
  • Fax: 501-835-6905
Mailing address:
  • Phone: 501-833-0087
  • Fax: 501-835-6905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BD1200X
TaxonomyDialysis Equipment & Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. TODD L LUTH
Title or Position: MEMBER/OWNER
Credential:
Phone: 501-833-5627