1114370798 NPI number — BASIN INFECTIOUS DISEASES ASSOCIATES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114370798 NPI number — BASIN INFECTIOUS DISEASES ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BASIN INFECTIOUS DISEASES ASSOCIATES
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:
1114370798
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/25/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5813 CRANSTON PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDLAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79707-5025
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:
318 N ALLEGHANEY AVE
Provider Second Line Business Practice Location Address:
STE 300
Provider Business Practice Location Address City Name:
ODESSA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79761-5052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
432-288-4900
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/19/2016

Additional Information

Authorized Official

Authorized Official Last Name:
MOCHERLA
Authorized Official First Name:
SATISH
Authorized Official Middle Name:
MURTY
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
432-288-4900

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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