Provider Demographics
NPI:1053614461
Name:BAYBURY MEDICAL INC
Entity type:Organization
Organization Name:BAYBURY MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
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 1:1051 LANTRIP RD
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72120-4161
Mailing Address - Country:US
Mailing Address - Phone:501-833-0087
Mailing Address - Fax:501-835-6905
Practice Address - Street 1:1051 LANTRIP RD
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-4161
Practice Address - Country:US
Practice Address - Phone:501-833-0087
Practice Address - Fax:501-835-6905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies