Provider Demographics
NPI:1861002313
Name:BAXCARE CLINICAL CONSULTANTS
Entity Type:Organization
Organization Name:BAXCARE CLINICAL CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LATASHA
Authorized Official - Middle Name:N
Authorized Official - Last Name:BAXTER
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP-A
Authorized Official - Phone:716-310-5495
Mailing Address - Street 1:1811 SNOWDROP LN
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-3361
Mailing Address - Country:US
Mailing Address - Phone:716-310-5495
Mailing Address - Fax:
Practice Address - Street 1:1811 SNOWDROP LN
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-3361
Practice Address - Country:US
Practice Address - Phone:716-310-5495
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-08
Last Update Date:2020-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251F00000XAgenciesHome Infusion
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
00OtherN/A