Basham, Mark A

Basham, Mark A is an individual health care provider with primary practice located at 110 E 16Th St , Eureka KS 67045-1067. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Basham, Mark A can be contacted via phone (620) 583-7451.

Contact Information

Primary practice address
110 E 16Th St Eureka KS 67045-1067
Phone: (620) 583-7451
Fax: (620) 583-6702
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 0428069 Kansas

Profile Details

NPI number 1255326443
LBN Legal business name Basham, Mark A
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 14th, 2005
Last updated Nov 29th, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1255326443 NPPES
Kansas MEDICAID 100362190B
Kansas Other 100428860A
Kansas Other 178960
Kansas Other 640311

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