Healthcare Provider Details

I. General information

NPI: 1508562059
Provider Name (Legal Business Name): BAXLEY ANESTHETICS OF KANSAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2023
Last Update Date: 02/06/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10409 STATE HIGHWAY 43
WEBB CITY MO
64870-9723
US

IV. Provider business mailing address

10409 STATE HIGHWAY 43
WEBB CITY MO
64870-9723
US

V. Phone/Fax

Practice location:
  • Phone: 417-529-3436
  • Fax:
Mailing address:
  • Phone: 417-529-3436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRYAN O'NEAL BAXLEY
Title or Position: PRESIDENT
Credential: CRNA
Phone: 417-529-3436