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General NPI Number Information
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NPI Number | 1346541869
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Entity Type | Organization
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Legal Business Name | PATRIOT ANESTHESIA LLC
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Dates
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Enumeration Date | 11/15/2010
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Last Update Date | 06/22/2011
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Provider Practice Location Address
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Address Line | 1800 W UNIVERSITY BLVD
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City | DURANT
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State | OK
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Zip | 74701-3006
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Country | US
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Telephone | 405-926-7348
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Fax | 405-207-9956
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Provider Business Mailing Address
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Address Line | 35907 E COUNTY ROAD 1600
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City | PAULS VALLEY
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State | OK
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Zip | 73075-9070
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Country | US
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Telephone | 405-926-7348
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Fax | 405-207-9956
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAMES MARTIN BASHAW
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Credential | CRNA
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Telephone | 405-926-7348
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 75945
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License Number State | OK
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