Healthcare Provider Details

I. General information

NPI: 1144215781
Provider Name (Legal Business Name): ELLIOT L. BASS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 HUEBNER RD
FORT RILEY KS
66442-4030
US

IV. Provider business mailing address

2113 THOMPSON DR
JUNCTION CITY KS
66441-1912
US

V. Phone/Fax

Practice location:
  • Phone: 785-239-7179
  • Fax:
Mailing address:
  • Phone: 816-536-4356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberR5D26
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: