1184753881 NPI number — MS. BECKY LYNNE BASFORD CNP

Table of content: MS. BECKY LYNNE BASFORD CNP (NPI 1184753881)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184753881 NPI number — MS. BECKY LYNNE BASFORD CNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BASFORD
Provider First Name:
BECKY
Provider Middle Name:
LYNNE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CNP
Provider Gender Code:
F

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:
1184753881
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
210 N WILSON DR
Provider Second Line Business Mailing Address:
ADAMS COUNTY HOSPITAL
Provider Business Mailing Address City Name:
WEST UNION
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45693-1577
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-544-1531
Provider Business Mailing Address Fax Number:
937-544-1120

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
210 N WILSON DR
Provider Second Line Business Practice Location Address:
ADAMS COUNTY HOSPITAL
Provider Business Practice Location Address City Name:
WEST UNION
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45693-1577
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-544-1531
Provider Business Practice Location Address Fax Number:
937-544-1120
Provider Enumeration Date:
03/06/2007

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: 363LF0000X , with the licence number:  RN212420 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2264615 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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