MEDICARE: HENRY BAXLEY

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	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1366288268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HENRY BAXLEY

Provider Business Mailing Address
First Line	:	2676 ROCK HILL RD
Second Line	:
City	:	COLFAX
State	:	LA
Zip	:	71417-5309
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2676 ROCK HILL RD
Second Line	:
City	:	COLFAX
State	:	LA
Zip	:	71417-5309
Country	:	US
Telephone Number	:	318-715-9121
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2024
Last Update Date	:	09/04/2024

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Directions to “ HENRY BAXLEY ” Practice Location

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