MEDICARE: HAL J BASHEIN 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	208800000X	Urology Physician	OS 6143	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	P01649227	OTHER	FL	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	204650	OTHER	FL	AVMED
2	P03512	OTHER	FL	FREEDOM
3	0642985	OTHER	FL	CIGNA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	4404227	OTHER	FL	AETNA
7	80572	OTHER	FL	BCBS
8	P971487	OTHER	FL	OPTIMUM
9	1241662	OTHER	FL	WELLCARE
10	3437	OTHER	FL	DIMENSION
11	1010099	OTHER	FL	CAREPLUS
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306818083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAL J BASHEIN D.O.

Provider Business Mailing Address
First Line	:	2234 COLONIAL BLVD
Second Line	:	ATTN: PAYER CONTRACTING & RELATIONS DEPT.
City	:	FORT MYERS
State	:	FL
Zip	:	33907-1412
Country	:	US
Telephone Number	:	239-931-7342
Fax Number	:	239-931-7385

Provider Business Practice Location Address
First Line	:	2051 45TH ST
Second Line	:	SUITE 203
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-2027
Country	:	US
Telephone Number	:	561-848-8700
Fax Number	:	561-848-7070

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

Provider Enumeration Date	:	02/06/2006
Last Update Date	:	11/09/2016

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