Healthcare Provider Details

I. General information

NPI: 1548228869
Provider Name (Legal Business Name): BASHAM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

386 S LOCUST ST
MANTENO IL
60950-1604
US

IV. Provider business mailing address

386 S LOCUST ST
MANTENO IL
60950-1604
US

V. Phone/Fax

Practice location:
  • Phone: 815-468-0200
  • Fax: 815-468-0600
Mailing address:
  • Phone: 815-468-0200
  • Fax: 815-468-0600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MR. MARTY BASHAM
Title or Position: PRESIDENT
Credential:
Phone: 815-468-0200