Provider Demographics
NPI:1568036481
Name:BASKA, KATELYNN
Entity Type:Individual
Prefix:
First Name:KATELYNN
Middle Name:
Last Name:BASKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PRISMA HEALTH EMERGENCY MEDICINE DEPARTMENT
Mailing Address - Street 2:14 MEDICAL PARK, SUITE 350
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203
Mailing Address - Country:US
Mailing Address - Phone:803-434-7088
Mailing Address - Fax:803-434-3946
Practice Address - Street 1:PRISMA HEALTH EMERGENCY MEDICINE DEPARTMENT
Practice Address - Street 2:14 MEDICAL PARK, SUITE 350
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203
Practice Address - Country:US
Practice Address - Phone:803-434-7088
Practice Address - Fax:803-434-3946
Is Sole Proprietor?:No
Enumeration Date:2021-05-15
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL83611207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine