1306818083 NPI number — HAL J BASHEIN D.O.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306818083 NPI number — HAL J BASHEIN D.O.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

BASHEIN

Provider First Name:

HAL

Provider Middle Name:

J

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

D.O.

Provider Gender Code:

M

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:

1306818083

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

11/09/2016

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

2234 COLONIAL BLVD

Provider Second Line Business Mailing Address:

ATTN: PAYER CONTRACTING & RELATIONS DEPT.

Provider Business Mailing Address City Name:

FORT MYERS

Provider Business Mailing Address State Name:

FL

Provider Business Mailing Address Postal Code:

33907-1412

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

239-931-7342

Provider Business Mailing Address Fax Number:

239-931-7385

Provider First Line Business Practice Location Address:

2051 45TH ST

Provider Second Line Business Practice Location Address:

SUITE 203

Provider Business Practice Location Address City Name:

WEST PALM BEACH

Provider Business Practice Location Address State Name:

FL

Provider Business Practice Location Address Postal Code:

33407-2027

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

561-848-8700

Provider Business Practice Location Address Fax Number:

561-848-7070

Provider Enumeration Date:

02/06/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 208800000X , with the licence number:  OS 6143 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 204650 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: P03512 . This is a "FREEDOM" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 0642985 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 370525100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
• Identifier: 4404227 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: P01649227 . This is a "RR MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 80572 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: P971487 . This is a "OPTIMUM" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 1241662 . This is a "WELLCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 3437 . This is a "DIMENSION" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 1010099 . This is a "CAREPLUS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 006869500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".