Healthcare Provider Details

I. General information

NPI: 1629231725
Provider Name (Legal Business Name): MR. TREY HERRON BAXTER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 SPRINGRIDGE RD A5
CLINTON MS
39056-5671
US

IV. Provider business mailing address

507 BERKSHIRE ST
CLINTON MS
39056-3826
US

V. Phone/Fax

Practice location:
  • Phone: 601-941-2023
  • Fax: 601-922-5281
Mailing address:
  • Phone: 601-941-2023
  • Fax: 601-922-5281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: