Provider Demographics
NPI:1417170424
Name:NABIL BASHA, M.D., P.S.C.
Entity Type:Organization
Organization Name:NABIL BASHA, M.D., P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NABIL
Authorized Official - Middle Name:
Authorized Official - Last Name:BASHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-789-7040
Mailing Address - Street 1:PO BOX 707
Mailing Address - Street 2:
Mailing Address - City:PAINTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41240-0707
Mailing Address - Country:US
Mailing Address - Phone:606-789-7040
Mailing Address - Fax:606-789-3035
Practice Address - Street 1:713 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PAINTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41240-1465
Practice Address - Country:US
Practice Address - Phone:606-789-7040
Practice Address - Fax:606-789-3035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY197122086H0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086H0002XAllopathic & Osteopathic PhysiciansSurgeryHospice and Palliative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000047317OtherANTHEM
KY64197122Medicaid
0690171OtherUMWA
KOOO977OtherCHAMPUS
KY000000047317OtherANTHEM
C69577Medicare UPIN