Organization
BASHAM CLINIC, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK A BASHAM MD (OWNER)
(620) 750-0099
Entity
Organization
Contact information
Practice address
100 E 16TH ST, EUREKA, KS 67045-1067
(620) 750-0099
(620) 583-6397
Mailing address
PO BOX 63, ANDOVER, KS 67002-0063
(316) 633-4413
(877) 381-0101
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
04-28069
KS
Other
Enumeration date
05/20/2015
Last updated
05/20/2015
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