1700099868 NPI number — DR. DAVID F. BOWERS P.C.

Table of content: (NPI 1700099868)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700099868 NPI number — DR. DAVID F. BOWERS P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. DAVID F. BOWERS P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700099868
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 678
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRING GROVE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60081-0678
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-675-9090
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2100 N US HIGHWAY 12
Provider Second Line Business Practice Location Address:
STE 201
Provider Business Practice Location Address City Name:
SPRING GROVE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60081-8308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-675-9090
Provider Business Practice Location Address Fax Number:
815-207-7808
Provider Enumeration Date:
05/07/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BOWERS
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
FLOYD
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
815-675-9090

Provider Taxonomy Codes

  • Taxonomy code: 261QP1100X , with the licence number:  016-04951 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01626083 . This is a "BLUE CROSS BLUSHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".