Provider Demographics
NPI:1023150075
Name:BARRY BASS, MD, PA
Entity type:Organization
Organization Name:BARRY BASS, MD, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BASS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-293-9200
Mailing Address - Street 1:312 E RENFRO ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-3947
Mailing Address - Country:US
Mailing Address - Phone:817-293-9200
Mailing Address - Fax:877-838-0751
Practice Address - Street 1:312 E RENFRO ST
Practice Address - Street 2:SUITE 109
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-3947
Practice Address - Country:US
Practice Address - Phone:817-293-9200
Practice Address - Fax:877-838-0751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165042601Medicaid
TXP00182185OtherMEDICARE RAILROAD
TX00576WMedicare PIN
TXA11254Medicare UPIN