Provider Demographics
NPI:1215056064
Name:BASIN FAMILY CARE, INC
Entity type:Organization
Organization Name:BASIN FAMILY CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:D
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:432-332-5200
Mailing Address - Street 1:601 E 2ND ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-5435
Mailing Address - Country:US
Mailing Address - Phone:432-332-5200
Mailing Address - Fax:432-332-5201
Practice Address - Street 1:601 E 2ND ST
Practice Address - Street 2:SUITE G
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-5435
Practice Address - Country:US
Practice Address - Phone:432-332-5200
Practice Address - Fax:432-332-5201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX535063363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX157283602Medicaid
TX197278802Medicaid
TX197278801Medicaid
TX0056KXOtherBCBS
TX157283602Medicaid
TX197278802Medicaid