Provider Demographics
NPI:1912005109
Name:BASLER SKIN LLC
Entity Type:Organization
Organization Name:BASLER SKIN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:SW
Authorized Official - Last Name:BASLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-421-3335
Mailing Address - Street 1:2625 STOCKWELL ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-5755
Mailing Address - Country:US
Mailing Address - Phone:402-421-3335
Mailing Address - Fax:402-421-2625
Practice Address - Street 1:2625 STOCKWELL ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-5755
Practice Address - Country:US
Practice Address - Phone:402-421-3335
Practice Address - Fax:402-421-2625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Multi-Specialty
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric DermatologyGroup - Multi-Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty