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NPI Code Detail

MEDICARE: GLENDAIL BASS

MEDICARE: GLENDAIL BASS
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
1172V00000XCommunity Health Worker

General Provider Information

NPI Number : 1073955639
Entity Type Code : Individual
Provider Name (Legal Business Name) : GLENDAIL BASS
Provider Business Mailing Address
First Line : 2909 HAYLING DR
Second Line :
City : RALEIGH
State : NC
Zip : 27610-5268
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 839 WILKESBORO BLVD NE
Second Line :
City : LENOIR
State : NC
Zip : 28645-4612
Country : US
Telephone Number : 828-759-2228
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/24/2013
Last Update Date : 07/24/2013

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Directions to “ GLENDAIL BASS ” Practice Location

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