Healthcare Provider Details

I. General information

NPI: 1770738999
Provider Name (Legal Business Name): BASIN OCCUPATIONAL AND URGENT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2008
Last Update Date: 02/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1308 E 20TH ST
FARMINGTON NM
87401-9022
US

IV. Provider business mailing address

PO BOX 1806
BLOOMFIELD NM
87413-1806
US

V. Phone/Fax

Practice location:
  • Phone: 505-324-0149
  • Fax: 505-327-2197
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JASON CLARK
Title or Position: CLINIC DIRECTOR
Credential:
Phone: 505-324-0149