Provider Demographics
NPI:1588845382
Name:BETH ANNE BAXTER, RN/CS, LLC
Entity Type:Organization
Organization Name:BETH ANNE BAXTER, RN/CS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:BAXTER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:812-323-0971
Mailing Address - Street 1:822 W 1ST ST
Mailing Address - Street 2:STE 1
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-2384
Mailing Address - Country:US
Mailing Address - Phone:812-323-0971
Mailing Address - Fax:
Practice Address - Street 1:822 W 1ST ST
Practice Address - Street 2:STE 1
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-2384
Practice Address - Country:US
Practice Address - Phone:812-323-0971
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000050A207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN228060Medicare PIN
INY34932Medicare UPIN