1023150075 NPI number — BARRY BASS, MD, PA

Table of content: (NPI 1023150075)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023150075 NPI number — BARRY BASS, MD, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BARRY BASS, MD, PA
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:
Provider Other Organization Name Type Code:
6
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:
1023150075
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
312 E RENFRO ST
Provider Second Line Business Mailing Address:
SUITE 109
Provider Business Mailing Address City Name:
BURLESON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76028-3947
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-293-9200
Provider Business Mailing Address Fax Number:
877-838-0751

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
312 E RENFRO ST
Provider Second Line Business Practice Location Address:
SUITE 109
Provider Business Practice Location Address City Name:
BURLESON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76028-3947
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-293-9200
Provider Business Practice Location Address Fax Number:
877-838-0751
Provider Enumeration Date:
02/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BASS
Authorized Official First Name:
BARRY
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
817-293-9200

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 165042601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00182185 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com