Healthcare Provider Details

I. General information

NPI: 1639516545
Provider Name (Legal Business Name): HARRY BASSETT CONTRACTOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2013
Last Update Date: 11/13/2020
Certification Date: 11/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 MARCHWOOD CV
LITTLE ROCK AR
72210-3704
US

IV. Provider business mailing address

16 MARCHWOOD CV
LITTLE ROCK AR
72210-3704
US

V. Phone/Fax

Practice location:
  • Phone: 501-366-3585
  • Fax: 501-562-0998
Mailing address:
  • Phone: 501-366-3585
  • Fax: 501-562-0998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: