Provider Demographics
NPI:1871006437
Name:BASON DIAGNOSTICS
Entity Type:Organization
Organization Name:BASON DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-243-2761
Mailing Address - Street 1:2502 SILVERSIDE RD STE 4B
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-3740
Mailing Address - Country:US
Mailing Address - Phone:610-715-5637
Mailing Address - Fax:610-601-1911
Practice Address - Street 1:2502 SILVERSIDE RD STE 4B
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-3740
Practice Address - Country:US
Practice Address - Phone:610-715-5637
Practice Address - Fax:610-601-1911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-06
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA=========Medicaid