Provider Demographics
NPI:1962452243
Name:BAXTER SUPPLY SERVICES LLC
Entity type:Organization
Organization Name:BAXTER SUPPLY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCHAAF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-473-6121
Mailing Address - Street 1:1 BAXTER PKWY
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-4625
Mailing Address - Country:US
Mailing Address - Phone:847-940-5353
Mailing Address - Fax:847-940-5350
Practice Address - Street 1:1 BAXTER PKWY
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-4625
Practice Address - Country:US
Practice Address - Phone:847-940-5353
Practice Address - Fax:847-940-5350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL203000687332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL004970096OtherBCBS
IN100003830BMedicaid
TX121840601Medicaid
ID000237600Medicaid
AR123341741Medicaid
TN4580593Medicaid
KY90072331Medicaid
NY00828428Medicaid
OH0306645Medicaid
MN117863600Medicaid
MA7501749Medicaid
ND117863600Medicaid
CT003020260Medicaid
OK100793810AMedicaid
LA1336025Medicaid
MS4836880Medicaid
LA1336025Medicaid
AR123341741Medicaid