Provider Demographics
NPI:1033825203
Name:BASIN PEDIATRICS, LLC
Entity Type:Organization
Organization Name:BASIN PEDIATRICS, LLC
Other - Org Name:BASIN PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:SALAS
Authorized Official - Suffix:
Authorized Official - Credentials:CPNP
Authorized Official - Phone:432-218-8899
Mailing Address - Street 1:2013 MOSSWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-5078
Mailing Address - Country:US
Mailing Address - Phone:432-557-6350
Mailing Address - Fax:
Practice Address - Street 1:4410 N MIDKIFF RD STE D4
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705-4249
Practice Address - Country:US
Practice Address - Phone:432-557-6350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-30
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty