Provider Demographics
NPI:1023277100
Name:HARRY BASS, M.D., P.A.
Entity type:Organization
Organization Name:HARRY BASS, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BASS
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PA
Authorized Official - Phone:575-522-0330
Mailing Address - Street 1:2425 S TELSHOR BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-5049
Mailing Address - Country:US
Mailing Address - Phone:575-522-0330
Mailing Address - Fax:575-522-8620
Practice Address - Street 1:2425 S TELSHOR BLVD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-5049
Practice Address - Country:US
Practice Address - Phone:575-522-0330
Practice Address - Fax:575-522-8620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-04
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM77-5207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00NM000242OtherBCBS
201000575OtherPRESBYTERIAN HEALTH PLAN
524571OtherFIRST HEALTH LIFE AND HEALTH INSURANCE CO.
NM42184371Medicaid
NMA100883Medicare PIN
D43033Medicare UPIN