Provider Demographics
NPI:1508562059
Name:BAXLEY ANESTHETICS OF KANSAS
Entity Type:Organization
Organization Name:BAXLEY ANESTHETICS OF KANSAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:O'NEAL
Authorized Official - Last Name:BAXLEY
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:417-529-3436
Mailing Address - Street 1:10409 STATE HIGHWAY 43
Mailing Address - Street 2:
Mailing Address - City:WEBB CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64870-9723
Mailing Address - Country:US
Mailing Address - Phone:417-529-3436
Mailing Address - Fax:
Practice Address - Street 1:10409 STATE HIGHWAY 43
Practice Address - Street 2:
Practice Address - City:WEBB CITY
Practice Address - State:MO
Practice Address - Zip Code:64870-9723
Practice Address - Country:US
Practice Address - Phone:417-529-3436
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty