MEDICARE: BASIS INTERNAL MEDICINE LLC

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	M11082	ID

General Provider Information

NPI Number	:	1306385950
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BASIS INTERNAL MEDICINE LLC

Provider Business Mailing Address
First Line	:	7325 MEESHOW DR STE G
Second Line	:
City	:	SPRINGDALE
State	:	AR
Zip	:	72762-5258
Country	:	US
Telephone Number	:	208-789-2131
Fax Number	:	866-950-0277

Provider Business Practice Location Address
First Line	:	7325 MEESHOW DR STE G
Second Line	:
City	:	SPRINGDALE
State	:	AR
Zip	:	72762-5258
Country	:	US
Telephone Number	:	208-789-2131
Fax Number	:	866-950-0277

Authorized Official
Title or Position	:	OWNER
Name	:	HARRY A LAZARTE
Credential	:	MD
Telephone Number	:	402-253-6329

Provider Enumeration Date	:	02/15/2017
Last Update Date	:	01/29/2026

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