Provider Demographics
NPI:1346843323
Name:BASS MANAGEMENT SERVICES ORGANIZATION, LLC
Entity Type:Organization
Organization Name:BASS MANAGEMENT SERVICES ORGANIZATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-948-8143
Mailing Address - Street 1:2637 SHADELANDS DR
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2512
Mailing Address - Country:US
Mailing Address - Phone:925-948-8143
Mailing Address - Fax:925-215-4540
Practice Address - Street 1:2637 SHADELANDS DR STE G
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2512
Practice Address - Country:US
Practice Address - Phone:925-948-8143
Practice Address - Fax:925-215-4540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-20
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies