1003878042 NPI number — DR. JAMES WILLIAM BASS III M.D.

Table of content: DR. JAMES WILLIAM BASS III M.D. (NPI 1003878042)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003878042 NPI number — DR. JAMES WILLIAM BASS III M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BASS
Provider First Name:
JAMES
Provider Middle Name:
WILLIAM
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
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:
1003878042
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/10/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1800 W. 1ST ST.
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
ELK CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73644-2339
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-225-2515
Provider Business Mailing Address Fax Number:
580-303-5850

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 W. 1ST ST.
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
ELK CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73644-2339
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-225-2515
Provider Business Practice Location Address Fax Number:
580-303-5850
Provider Enumeration Date:
04/05/2006

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: 207Q00000X , with the licence number:  K2844 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: 31130 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 8AG193 . This is a "BCBS OF TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: TIN PLUS 002 . This is a "TRICARE LAKE PALESTINE LOCATION" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 514553 . This is a "PHCS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: TIN PLUS 029 . This is a "TRICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 75-2616977-001 . This is a "TRICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 121294606 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com