1962452243 NPI number — BAXTER SUPPLY SERVICES LLC

Table of content: (NPI 1962452243)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962452243 NPI number — BAXTER SUPPLY SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAXTER SUPPLY SERVICES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962452243
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 BAXTER PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEERFIELD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60015-4625
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-940-5353
Provider Business Mailing Address Fax Number:
847-940-5350

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 BAXTER PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEERFIELD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60015-4625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-940-5353
Provider Business Practice Location Address Fax Number:
847-940-5350
Provider Enumeration Date:
05/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SCHAAF
Authorized Official First Name:
JILL
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
847-473-6121

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  203000687 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 004970096 . This is a "BCBS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 100003830B , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 121840601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000237600 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 123341741 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4580593 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 90072331 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00828428 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0306645 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 117863600 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7501749 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 117863600 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003020260 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100793810A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1336025 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4836880 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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