Provider Demographics
NPI:1114370798
Name:BASIN INFECTIOUS DISEASES ASSOCIATES
Entity Type:Organization
Organization Name:BASIN INFECTIOUS DISEASES ASSOCIATES
Other - Org Name:BASIN INFECTIOUS DISEASES ASSOCIATES, PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SATISH
Authorized Official - Middle Name:MURTY
Authorized Official - Last Name:MOCHERLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:432-288-4900
Mailing Address - Street 1:5813 CRANSTON PL
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-5025
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:318 N ALLEGHANEY AVE
Practice Address - Street 2:STE 300
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-5052
Practice Address - Country:US
Practice Address - Phone:432-288-4900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-19
Last Update Date:2016-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty