Provider Demographics
NPI:1619257946
Name:BASIN NEUROSURGICAL AND SPINE ASSOCIATES
Entity Type:Organization
Organization Name:BASIN NEUROSURGICAL AND SPINE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALIM
Authorized Official - Middle Name:MIRZA
Authorized Official - Last Name:LADHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:432-687-6203
Mailing Address - Street 1:PO BOX 13562
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79768-3562
Mailing Address - Country:US
Mailing Address - Phone:432-687-9203
Mailing Address - Fax:432-687-6299
Practice Address - Street 1:400 N GARFIELD ST
Practice Address - Street 2:200
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-5904
Practice Address - Country:US
Practice Address - Phone:432-687-6203
Practice Address - Fax:432-687-6299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-18
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP7050207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty