Provider Demographics
NPI:1861510018
Name:BASEM JASSIN, MD PA
Entity Type:Organization
Organization Name:BASEM JASSIN, MD PA
Other - Org Name:ENNIS EAR, NOSE & THROAT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BASEM
Authorized Official - Middle Name:
Authorized Official - Last Name:JASSIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-875-9700
Mailing Address - Street 1:818 W ENNIS AVE
Mailing Address - Street 2:
Mailing Address - City:ENNIS
Mailing Address - State:TX
Mailing Address - Zip Code:75119-3810
Mailing Address - Country:US
Mailing Address - Phone:972-875-9700
Mailing Address - Fax:972-875-9721
Practice Address - Street 1:818 W ENNIS AVE
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119-3810
Practice Address - Country:US
Practice Address - Phone:972-875-9700
Practice Address - Fax:972-875-9721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDF4605OtherRAILROAD MC
TX153977701Medicaid
TX0021PUOtherBCBS GROUP
TX0021PUOtherBCBS GROUP
TX00176UMedicare PIN