MEDICARE: BAXLEY ANESTHETICS OF KANSAS

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	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1508562059
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAXLEY ANESTHETICS OF KANSAS

Provider Business Mailing Address
First Line	:	10409 STATE HIGHWAY 43
Second Line	:
City	:	WEBB CITY
State	:	MO
Zip	:	64870-9723
Country	:	US
Telephone Number	:	417-529-3436
Fax Number	:

Provider Business Practice Location Address
First Line	:	10409 STATE HIGHWAY 43
Second Line	:
City	:	WEBB CITY
State	:	MO
Zip	:	64870-9723
Country	:	US
Telephone Number	:	417-529-3436
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BRYAN O'NEAL BAXLEY
Credential	:	CRNA
Telephone Number	:	417-529-3436

Provider Enumeration Date	:	02/06/2023
Last Update Date	:	02/06/2023

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