1154303568 NPI number — DR. SCOTT LEE BASINGER DPM

Table of content: JONATHAN ORTIZ LCSW (NPI 1477836856)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154303568 NPI number — DR. SCOTT LEE BASINGER DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BASINGER
Provider First Name:
SCOTT
Provider Middle Name:
LEE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

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:
1154303568
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/24/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1060
Provider Second Line Business Mailing Address:
6602 ROBERTA ROAD
Provider Business Mailing Address City Name:
HARRISBURG
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28075-1060
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12610 N COMMUNITY HOUSE RD
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28277
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-541-3668
Provider Business Practice Location Address Fax Number:
704-541-3622
Provider Enumeration Date:
11/19/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213ES0131X , with the licence number:  433 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: NPD433 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2433613B . This is a "MEDICARE ID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 890804J , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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