Basic Information
| Provider Information | |||||||||
| NPI: | 1093945156 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BASIN CARDIOTHORACIC & VASCULAR SURGERY ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5293 | ||||||||
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| City: | MIDLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 797045293 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4326866600 | ||||||||
| FaxNumber: | 4326822284 | ||||||||
| Practice Location | |||||||||
| Address1: | 3001 W ILLINOIS AVE | ||||||||
| Address2: | SUITE 1A | ||||||||
| City: | MIDLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 797013180 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4326822191 | ||||||||
| FaxNumber: | 4326821707 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2009 | ||||||||
| LastUpdateDate: | 07/22/2009 | ||||||||
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| AuthorizedOfficialLastName: | BURKE | ||||||||
| AuthorizedOfficialFirstName: | RHONDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4326866600 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | PREMIER FAMILY CARE I, INC | ||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
No ID Information.