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General NPI Number Information
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NPI Number | 1063308344
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Entity Type | Individual
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Provider Name | MARY ELLEN BASS MD
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Gender | Female
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Dates
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Enumeration Date | 06/14/2025
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Last Update Date | 06/14/2025
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Provider Practice Location Address
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Address Line | 1 BARNES JEWISH HOSPITAL PLZ
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City | SAINT LOUIS
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State | MO
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Zip | 63110-1003
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Country | US
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Telephone | 314-747-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 4590 NASH WAY
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City | SAINT LOUIS
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State | MO
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Zip | 63110-1020
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Country | US
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Telephone | 314-363-5634
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | IA-0008025964
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License Number State | MO
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