Basham Clinic, P.a.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

04-28069 Issued in KS

Legal business name

BASHAM CLINIC, P.A.

Practice address

100 E 16TH St
Eureka, KS 67045-1067

Phone

(620) 750-0099

Fax

(620) 583-6397

NPI assigned

May 20, 2015

Last updated

May 20, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mark A Basham, MD

Title

Owner

Phone

(620) 750-0099

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1432080000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1432080000000",
    "number": "1124407341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 63",
            "city": "ANDOVER",
            "state": "KS",
            "postal_code": "670020063",
            "telephone_number": "316-633-4413",
            "fax_number": "877-381-0101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 E 16TH ST",
            "city": "EUREKA",
            "state": "KS",
            "postal_code": "670451067",
            "telephone_number": "620-750-0099",
            "fax_number": "620-583-6397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BASHAM CLINIC, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-20",
        "last_updated": "2015-05-20",
        "status": "A",
        "authorized_official_last_name": "BASHAM",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "620-750-0099",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "KS",
            "license": "04-28069",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Eureka, KS
• Providers in Eureka, KS by specialty
• Family Medicine Physician in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.