Provider Demographics
NPI:1871739714
Name:BASIN HEALTHCARE CENTER LLC
Entity type:Organization
Organization Name:BASIN HEALTHCARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:TROXELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-362-9900
Mailing Address - Street 1:900 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-5255
Mailing Address - Country:US
Mailing Address - Phone:432-362-9900
Mailing Address - Fax:432-362-9930
Practice Address - Street 1:900 E 4TH ST
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-5255
Practice Address - Country:US
Practice Address - Phone:432-362-9900
Practice Address - Fax:432-362-9930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-24
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
282N00000X
TX100045282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX282N00000XMedicaid
67-0066Medicare UPIN