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General NPI Number Information
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NPI Number | 1508562059
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Entity Type | Organization
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Legal Business Name | BAXLEY ANESTHETICS OF KANSAS
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Dates
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Enumeration Date | 02/06/2023
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Last Update Date | 02/06/2023
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Provider Practice Location Address
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Address Line | 10409 STATE HIGHWAY 43
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City | WEBB CITY
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State | MO
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Zip | 64870-9723
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Country | US
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Telephone | 417-529-3436
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Fax |
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Provider Business Mailing Address
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Address Line | 10409 STATE HIGHWAY 43
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City | WEBB CITY
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State | MO
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Zip | 64870-9723
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Country | US
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Telephone | 417-529-3436
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRYAN O'NEAL BAXLEY
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Credential | CRNA
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Telephone | 417-529-3436
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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