Provider Demographics
NPI:1316919525
Name:BASSO, JAMES MICHAEL (AUD)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:MICHAEL
Last Name:BASSO
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 WILMINGTON DR
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147
Mailing Address - Country:US
Mailing Address - Phone:440-526-4707
Mailing Address - Fax:
Practice Address - Street 1:1618 COOPER FOSTER PARK RD
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053
Practice Address - Country:US
Practice Address - Phone:440-282-4300
Practice Address - Fax:440-960-5562
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA01207231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH04730OtherNATIONAL EAR CARE PLAN
OH0085287Medicaid
OH000000363720OtherANTHEM
OH341018435029OtherCARESOURCE GROUP
OHBA4104341Medicare ID - Type Unspecified