Provider Demographics
NPI:1962688622
Name:BASS, RONNIE PATRICK
Entity Type:Individual
Prefix:
First Name:RONNIE
Middle Name:PATRICK
Last Name:BASS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 SHADY OAK ST
Mailing Address - Street 2:
Mailing Address - City:BURNET
Mailing Address - State:TX
Mailing Address - Zip Code:78611-2634
Mailing Address - Country:US
Mailing Address - Phone:512-756-2238
Mailing Address - Fax:
Practice Address - Street 1:203 SHADY OAK ST
Practice Address - Street 2:
Practice Address - City:BURNET
Practice Address - State:TX
Practice Address - Zip Code:78611-2634
Practice Address - Country:US
Practice Address - Phone:512-756-2238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No171WH0202XOther Service ProvidersContractorHome Modifications
No172A00000XOther Service ProvidersDriver
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
No374700000XNursing Service Related ProvidersTechnician
No376J00000XNursing Service Related ProvidersHomemaker