NPIMap

Organization Active NPI

Retired

  • Medical Specialty Clinic/Center
  • Hallsville, MO
National Provider Identifier
1962818435
Registry record updated Jul 6, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Specialty Clinic/CenterTaxonomy code 261QM2500X
License
R5108 Issued in MO
Legal business name
RETIRED
Practice address
13714 N Sportsmans Dr
Hallsville, MO 65255-9330
Phone
(573) 696-2391
NPI assigned
Jul 6, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2014

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

Authorized official

Name
Herb Bastow, M.D.
Title
Urologist
Phone
(573) 696-2391

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Specialty Clinic/Center 261QM2500X R5108 MO Primary

Addresses

Primary practice location

13714 N Sportsmans Dr
Hallsville, MO 65255-9330

Mailing address

13714 N Sportsmans Dr
Hallsville, MO 65255-9330
Phone (573) 696-2391

National Provider Directory

National Provider Directory
Tax ID family
Hickman Mills Clinic Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1404604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1404604800000",
    "number": "1962818435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13714 N SPORTSMANS DR",
            "city": "HALLSVILLE",
            "state": "MO",
            "postal_code": "652559330",
            "telephone_number": "573-696-2391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13714 N SPORTSMANS DR",
            "city": "HALLSVILLE",
            "state": "MO",
            "postal_code": "652559330",
            "telephone_number": "573-696-2391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RETIRED",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-06",
        "last_updated": "2014-07-06",
        "status": "A",
        "authorized_official_last_name": "BASTOW",
        "authorized_official_first_name": "HERB",
        "authorized_official_title_or_position": "UROLOGIST",
        "authorized_official_telephone_number": "573-696-2391",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "MO",
            "license": "R5108",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hallsville, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2014; 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.