Provider Demographics
NPI:1295988830
Name:BASIN PARAMEDICAL EXAM SERVICES LLC
Entity type:Organization
Organization Name:BASIN PARAMEDICAL EXAM SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MNGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HADLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:PME/CLP
Authorized Official - Phone:435-789-9440
Mailing Address - Street 1:1389 W HIGHWAY 40
Mailing Address - Street 2:SUITE B
Mailing Address - City:VERNAL
Mailing Address - State:UT
Mailing Address - Zip Code:84078-4204
Mailing Address - Country:US
Mailing Address - Phone:435-789-9440
Mailing Address - Fax:435-789-9441
Practice Address - Street 1:1389 W HIGHWAY 40
Practice Address - Street 2:SUITE B
Practice Address - City:VERNAL
Practice Address - State:UT
Practice Address - Zip Code:84078-4204
Practice Address - Country:US
Practice Address - Phone:435-789-9440
Practice Address - Fax:435-789-9441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory