Healthcare Provider Details

I. General information

NPI: 1154912210
Provider Name (Legal Business Name): WILLIAM A BASS HAD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2021
Last Update Date: 02/01/2021
Certification Date: 02/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 E SANGER ST STE B
HOBBS NM
88240-4504
US

IV. Provider business mailing address

812 E SANGER ST STE B
HOBBS NM
88240-4504
US

V. Phone/Fax

Practice location:
  • Phone: 575-393-3056
  • Fax: 575-391-7899
Mailing address:
  • Phone: 575-393-3056
  • Fax: 575-391-7899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHAD770
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: