Provider Demographics
NPI:1780189142
Name:BASEWAVE PROPERTIES, PLLC
Entity Type:Organization
Organization Name:BASEWAVE PROPERTIES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CLARIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-532-0863
Mailing Address - Street 1:4808 FAIRMONT PKWY # 404
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77505-3722
Mailing Address - Country:US
Mailing Address - Phone:832-532-0863
Mailing Address - Fax:281-754-4278
Practice Address - Street 1:4808 FAIRMONT PKWY
Practice Address - Street 2:#404
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505
Practice Address - Country:US
Practice Address - Phone:832-532-0863
Practice Address - Fax:281-754-4278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-28
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTIN