Basic Information
| Provider Information | |||||||||
| NPI: | 1578698973 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BAYBURY MEDICAL, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 BROOKSWOOD RD | ||||||||
| Address2: | |||||||||
| City: | SHERWOOD | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721204202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5018335627 | ||||||||
| FaxNumber: | 5018356905 | ||||||||
| Practice Location | |||||||||
| Address1: | 120 BROOKSWOOD RD | ||||||||
| Address2: | |||||||||
| City: | SHERWOOD | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721204202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5018335627 | ||||||||
| FaxNumber: | 5018356905 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2007 | ||||||||
| LastUpdateDate: | 07/17/2012 | ||||||||
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| AuthorizedOfficialLastName: | LUTH | ||||||||
| AuthorizedOfficialFirstName: | RUSSELL | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | REGISTERED AGENT | ||||||||
| AuthorizedOfficialTelephone: | 5018335627 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.