MEDICARE: CLAYTON BASS MD FACEP PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207PE0005X	Undersea and Hyperbaric Medicine (Emergency Medicine) Physician	6068769-1205	UT

General Provider Information

NPI Number	:	1033418009
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLAYTON BASS MD FACEP PC

Provider Business Mailing Address
First Line	:	434 E 5350 S
Second Line	:	SUITE B
City	:	OGDEN
State	:	UT
Zip	:	84405-6931
Country	:	US
Telephone Number	:	801-475-7100
Fax Number	:	801-475-7101

Provider Business Practice Location Address
First Line	:	434 E 5350 S
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84405-6931
Country	:	US
Telephone Number	:	801-475-7100
Fax Number	:	801-475-7101

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	LINDSI JENKINS
Credential	:
Telephone Number	:	801-475-7100

Provider Enumeration Date	:	03/16/2011
Last Update Date	:	03/16/2011

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