Provider Demographics
NPI:1790544567
Name:BASS MEDICAL GROUP
Entity Type:Organization
Organization Name:BASS MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENROLLMENT COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:HEWITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-378-4512
Mailing Address - Street 1:2637 SHADELANDS DR
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2512
Mailing Address - Country:US
Mailing Address - Phone:925-627-3424
Mailing Address - Fax:
Practice Address - Street 1:763 ALTOS OAKS DR STE 2
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94024-5400
Practice Address - Country:US
Practice Address - Phone:408-356-0444
Practice Address - Fax:408-358-5125
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BASS MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty