MEDICARE: BASIN PALLIATIVE CARE INC

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	207QH0002X	Hospice and Palliative Medicine (Family Medicine) Physician

General Provider Information

NPI Number	:	1396692935
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BASIN PALLIATIVE CARE INC

Provider Business Mailing Address
First Line	:	200 N ORCHARD AVE
Second Line	:
City	:	FARMINGTON
State	:	NM
Zip	:	87401-6225
Country	:	US
Telephone Number	:	505-325-8231
Fax Number	:	505-325-4516

Provider Business Practice Location Address
First Line	:	110 E ARRINGTON ST
Second Line	:
City	:	FARMINGTON
State	:	NM
Zip	:	87401-6910
Country	:	US
Telephone Number	:	505-325-8231
Fax Number	:	505-325-4516

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	MS. SHEALA MOFFITT
Credential	:
Telephone Number	:	505-325-8231

Provider Enumeration Date	:	03/12/2026
Last Update Date	:	05/26/2026

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Directions to “BASIN PALLIATIVE CARE INC ” Practice Location

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