Provider Demographics
NPI:1629449996
Name:BASH FAMILY PRACTICE
Entity Type:Organization
Organization Name:BASH FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRNP
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:BASH
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:724-285-1988
Mailing Address - Street 1:166 MOORE RD
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 RENAISSANCE DR
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-7612
Practice Address - Country:US
Practice Address - Phone:724-285-1988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-13
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP005043B261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care