1407826233 NPI number — DR. ASHISH KUMAR BASU M.D.

Table of content: DENCY THOMAS (NPI 1831603679)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407826233 NPI number — DR. ASHISH KUMAR BASU M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BASU
Provider First Name:
ASHISH
Provider Middle Name:
KUMAR
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1407826233
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/25/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
930 FRANKLIN ST SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTSVILLE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35801-4312
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-539-4080
Provider Business Mailing Address Fax Number:
256-539-4099

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2424 DANVILLE RD SW
Provider Second Line Business Practice Location Address:
SUITE L
Provider Business Practice Location Address City Name:
DECATUR
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35603-4280
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-351-0688
Provider Business Practice Location Address Fax Number:
256-353-8894
Provider Enumeration Date:
01/24/2006

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: 207RC0000X , with the licence number:  22653 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 112957 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4041982 . This is a "BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 510-49222 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 112956 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051509636 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 112949 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 25-10769 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 515-98439 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 515-98440 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 515-98442 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 510-49221 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 112943 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 112953 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 515-98443 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51509636 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 060068573 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 112947 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4469236 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".




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