Provider Demographics
NPI:1033418009
Name:CLAYTON BASS MD FACEP PC
Entity Type:Organization
Organization Name:CLAYTON BASS MD FACEP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDSI
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-475-7100
Mailing Address - Street 1:434 E 5350 S
Mailing Address - Street 2:SUITE B
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405-6931
Mailing Address - Country:US
Mailing Address - Phone:801-475-7100
Mailing Address - Fax:801-475-7101
Practice Address - Street 1:434 E 5350 S
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-6931
Practice Address - Country:US
Practice Address - Phone:801-475-7100
Practice Address - Fax:801-475-7101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6068769-1205207PE0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric MedicineGroup - Single Specialty