MEDICARE: DR. CARRIE A BASSETT D.O.

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	207R00000X	Internal Medicine Physician	34-008430	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043278872
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARRIE A BASSETT D.O.

Provider Business Mailing Address
First Line	:	PO BOX 932127
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44193-0001
Country	:	US
Telephone Number	:	216-472-2730
Fax Number	:	216-472-2740

Provider Business Practice Location Address
First Line	:	11201 SHAKER BLVD
Second Line	:	SUITE 102A
City	:	CLEVELAND
State	:	OH
Zip	:	44104-3869
Country	:	US
Telephone Number	:	216-721-6900
Fax Number	:	216-268-7905

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	03/30/2011

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