| Basis Internal Medicine Llc | |
|
1036 E Iron Eagle Dr Ste 107 Eagle ID 83616-6558 | |
| (208) 789-2131 | |
| (866) 950-0277 |
| Full Name | Basis Internal Medicine Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1036 E Iron Eagle Dr Ste 107, Eagle, Idaho |
| Authorized Official Name and Position | Harry A Lazarte (OWNER) |
| Authorized Official Contact | 4022536329 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Basis Internal Medicine Llc 1036 E Iron Eagle Dr Ste 107 Eagle ID 83616-6558 Ph: (208) 789-2131 | Basis Internal Medicine Llc 1036 E Iron Eagle Dr Ste 107 Eagle ID 83616-6558 Ph: (208) 789-2131 |
| NPI Number | 1306385950 |
|---|---|
| Provider Enumeration Date | 02/15/2017 |
| Last Update Date | 03/24/2021 |
| Medicare PECOS PAC ID | 8325324650 |
|---|---|
| Medicare Enrollment ID | O20170420001784 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306385950 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | M11082 (Idaho) | Primary |
| Provider Name | Harry Lazarte |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1548486053 PECOS PAC ID: 1456424274 Enrollment ID: I20101105001023 |
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