NPIMap

Organization Active NPI

Bazzano Clinic PA

  • Family Medicine Physician
  • Galena, KS
National Provider Identifier
1558699017
Registry record updated Aug 16, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
32305 Issued in MO
Legal business name
BAZZANO CLINIC PA
Practice address
111 E 7TH St
Galena, KS 66739-1229
Phone
(620) 783-1358
Fax
(620) 783-5055
NPI assigned
Nov 21, 2009
Last updated
Aug 16, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2010

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

Authorized official

Name
Stephen J Bazzano, D.O.NPI 1063423150
Title
Owner
Phone
(417) 781-2638

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 32305 MO Primary

Addresses

Primary practice location

111 E 7TH St
Galena, KS 66739-1229

Mailing address

PO Box 277
Galena, KS 66739-0277
Phone (620) 783-1358

Other identifiers 3

IdentifierTypeStateIssuer
100098210AMedicaidKS
240387605MedicaidMO
080075003OtherKSPALMETTO GBA RAILROAD MCR

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1258761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1281916800000",
    "number": "1558699017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 277",
            "city": "GALENA",
            "state": "KS",
            "postal_code": "667390277",
            "telephone_number": "620-783-1358",
            "fax_number": "620-783-5055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 E 7TH ST",
            "city": "GALENA",
            "state": "KS",
            "postal_code": "667391229",
            "telephone_number": "620-783-1358",
            "fax_number": "620-783-5055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAZZANO CLINIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-21",
        "last_updated": "2010-08-16",
        "status": "A",
        "authorized_official_last_name": "BAZZANO",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "417-781-2638",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "32305",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100098210A",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "240387605",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO GBA RAILROAD MCR",
            "identifier": "080075003",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Galena, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2010; 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.