Provider Demographics
NPI:1578698973
Name:BAYBURY MEDICAL, INC
Entity Type:Organization
Organization Name:BAYBURY MEDICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:L
Authorized Official - Last Name:LUTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-833-5627
Mailing Address - Street 1:120 BROOKSWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72120-4202
Mailing Address - Country:US
Mailing Address - Phone:501-833-5627
Mailing Address - Fax:501-835-6905
Practice Address - Street 1:120 BROOKSWOOD RD
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-4202
Practice Address - Country:US
Practice Address - Phone:501-833-5627
Practice Address - Fax:501-835-6905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies