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General NPI Number Information
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NPI Number | 1205319050
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Entity Type | Individual
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Provider Name | LEON BASS JR. NRP
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Gender | Male
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Dates
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Enumeration Date | 09/07/2018
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | 6280 SUNNY POINT RD BLDG 44
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City | SOUTHPORT
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State | NC
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Zip | 28461-7800
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Country | US
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Telephone | 910-457-8218
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Fax |
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Provider Business Mailing Address
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Address Line | 311 FIRE TOWER RD
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City | RICHLANDS
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State | NC
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Zip | 28574-8161
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Country | US
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Telephone |
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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 | 207PE0004X
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Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
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License Number | P024529
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License Number State | NC
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