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NPI Code Detail

MEDICARE: RICHARD M BASS M.D.

MEDICARE: RICHARD M BASS M.D.
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
1207Y00000XOtolaryngology Physician036042867IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1609862200
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICHARD M BASS M.D.
Provider Business Mailing Address
First Line : PO BOX 19639
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62794-9639
Country : US
Telephone Number : 217-545-7578
Fax Number : 217-545-1884
Provider Business Practice Location Address
First Line : 301 N 8TH ST
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62701-1041
Country : US
Telephone Number : 217-545-6099
Fax Number : 217-545-0253
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2005
Last Update Date : 10/16/2020

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