Provider Demographics
NPI:1730629411
Name:BASEDOW FAMILY CLINIC INC
Entity type:Organization
Organization Name:BASEDOW FAMILY CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:BASEDOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-532-3100
Mailing Address - Street 1:2301 S 7TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:IRONTON
Mailing Address - State:OH
Mailing Address - Zip Code:45638-2542
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2301 S 7TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638-2542
Practice Address - Country:US
Practice Address - Phone:740-532-3100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-01
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34005685332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site