Provider Demographics
NPI:1689270803
Name:BASTION HEALTH INC
Entity Type:Organization
Organization Name:BASTION HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:REZA
Authorized Official - Middle Name:
Authorized Official - Last Name:AMIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-245-1670
Mailing Address - Street 1:400 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-1913
Mailing Address - Country:US
Mailing Address - Phone:860-245-1670
Mailing Address - Fax:
Practice Address - Street 1:115 N CALHOUN ST STE 4
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-1568
Practice Address - Country:US
Practice Address - Phone:617-678-3881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BASTION HEALTH HOLDINGS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-11
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty