MEDICARE: EXPERIENCE BASSAM, 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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1396627717
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXPERIENCE BASSAM, LLC

Provider Business Mailing Address
First Line	:	8020 N 56TH ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33617-7600
Country	:	US
Telephone Number	:	813-397-8066
Fax Number	:

Provider Business Practice Location Address
First Line	:	8020 N 56TH ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33617-7600
Country	:	US
Telephone Number	:	813-397-8066
Fax Number	:

Authorized Official
Title or Position	:	MGR
Name	:	LEE DAWSON SR.
Credential	:
Telephone Number	:	813-397-8066

Provider Enumeration Date	:	07/25/2025
Last Update Date	:	07/25/2025

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Directions to “EXPERIENCE BASSAM, LLC ” Practice Location

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