Basic Information
| Provider Information | |||||||||
| NPI: | 1821184193 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALBARCHA | ||||||||
| FirstName: | BASSAM | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD,FACP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 N 8TH ST | ||||||||
| Address2: | SUITE 238 | ||||||||
| City: | EAST SAINT LOUIS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622012989 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182749105 | ||||||||
| FaxNumber: | 6182749101 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 N 8TH ST | ||||||||
| Address2: | SUITE 238 | ||||||||
| City: | EAST SAINT LOUIS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622012989 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182749105 | ||||||||
| FaxNumber: | 6182749101 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2006 | ||||||||
| LastUpdateDate: | 04/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 036096687 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 036096687 | 05 | IL | MEDICAID |