Healthcare Provider Details

I. General information

NPI: 1588845382
Provider Name (Legal Business Name): BETH ANNE BAXTER, RN/CS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2007
Last Update Date: 11/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

822 W 1ST ST STE 1
BLOOMINGTON IN
47403-2384
US

IV. Provider business mailing address

822 W 1ST ST STE 1
BLOOMINGTON IN
47403-2384
US

V. Phone/Fax

Practice location:
  • Phone: 812-323-0971
  • Fax:
Mailing address:
  • Phone: 812-323-0971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number71000050A
License Number StateIN

VIII. Authorized Official

Name: BETH A BAXTER
Title or Position: PRESIDENT
Credential: NP
Phone: 812-323-0971