MEDICARE: SAM BAXTER AND COMPANY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1053372581
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAM BAXTER AND COMPANY INC

Provider Business Mailing Address
First Line	:	1842 KINGSTON AVE
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23503-2610
Country	:	US
Telephone Number	:	757-480-3553
Fax Number	:	757-333-6855

Provider Business Practice Location Address
First Line	:	1842 KINGSTON AVE
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23503-2610
Country	:	US
Telephone Number	:	757-480-3553
Fax Number	:	757-333-6855

Authorized Official
Title or Position	:	CEO
Name	:	MR. SAMUEL L BAXTER
Credential	:
Telephone Number	:	757-480-3553

Provider Enumeration Date	:	04/02/2006
Last Update Date	:	08/22/2020

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