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General NPI Number Information
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NPI Number | 1558699017
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Entity Type | Organization
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Legal Business Name | BAZZANO CLINIC PA
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Dates
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Enumeration Date | 11/21/2009
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Last Update Date | 08/16/2010
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Provider Practice Location Address
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Address Line | 111 E 7TH ST
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City | GALENA
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State | KS
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Zip | 66739-1229
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Country | US
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Telephone | 620-783-1358
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Fax | 620-783-5055
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Provider Business Mailing Address
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Address Line | PO BOX 277
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City | GALENA
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State | KS
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Zip | 66739-0277
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Country | US
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Telephone | 620-783-1358
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Fax | 620-783-5055
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Authorized Official
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Title or Position | OWNER
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Name | STEPHEN J BAZZANO
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Credential | D.O.
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Telephone | 417-781-2638
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 32305
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License Number State | MO
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