Provider Demographics
NPI:1831876861
Name:BASIN MEDICAL TRANSPORTATION
Entity type:Organization
Organization Name:BASIN MEDICAL TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:MEAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-281-2148
Mailing Address - Street 1:2526 GARDEN AVE
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-3548
Mailing Address - Country:US
Mailing Address - Phone:541-205-5661
Mailing Address - Fax:541-205-5694
Practice Address - Street 1:2526 GARDEN AVE
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-3548
Practice Address - Country:US
Practice Address - Phone:541-205-5661
Practice Address - Fax:541-205-5694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1861097826Medicaid