Provider Demographics
NPI:1720086143
Name:BASEDOW FAMILY CLINIC INC
Entity Type:Organization
Organization Name:BASEDOW FAMILY CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:K
Authorized Official - Last Name:BASEDOW
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:740-532-3100
Mailing Address - Street 1:2301 S 7TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:OH
Mailing Address - Zip Code:45638-2542
Mailing Address - Country:US
Mailing Address - Phone:740-532-3100
Mailing Address - Fax:740-532-8558
Practice Address - Street 1:2301 S 7TH ST STE 1
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638-2542
Practice Address - Country:US
Practice Address - Phone:740-532-3100
Practice Address - Fax:740-532-8558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-09
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0919171Medicaid
OH0919180Medicaid
OH0919180Medicaid