1215159306 NPI number — SANGHAMITRA BASU MD PC

Table of content: (NPI 1215159306)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215159306 NPI number — SANGHAMITRA BASU MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SANGHAMITRA BASU MD PC
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:
SANS PAIN CLINIC
Provider Other Organization Name Type Code:
3
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:
1215159306
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6955 N. DURANGO DRIVE
Provider Second Line Business Mailing Address:
STE #1115-301
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89149-4411
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-362-7246
Provider Business Mailing Address Fax Number:
702-362-7272

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2435 FIRE MESA ST
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89128-9009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-362-7246
Provider Business Practice Location Address Fax Number:
702-362-7272
Provider Enumeration Date:
05/02/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BASU
Authorized Official First Name:
SANGHAMITRA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRINCIPAL
Authorized Official Telephone Number:
702-362-7246

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207LA0401X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207LP2900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0014X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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