1114132503 NPI number — LARRY HOWARD LEE BOWEN ARRT(R) EMT(B)

Table of content: LARRY HOWARD LEE BOWEN ARRT(R) EMT(B) (NPI 1114132503)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114132503 NPI number — LARRY HOWARD LEE BOWEN ARRT(R) EMT(B)

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOWEN
Provider First Name:
LARRY
Provider Middle Name:
HOWARD LEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARRT(R) EMT(B)
Provider Gender Code:
M

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:
1114132503
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
599 TOMALES RD
Provider Second Line Business Mailing Address:
HEALTH SERVICES 'A' SCHOOL
Provider Business Mailing Address City Name:
PETALUMA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94952-5002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-765-7488
Provider Business Mailing Address Fax Number:
707-765-7495

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
599 TOMALES RD
Provider Second Line Business Practice Location Address:
HEALTH SERVICES 'A' SCHOOL
Provider Business Practice Location Address City Name:
PETALUMA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94952-5002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-765-7488
Provider Business Practice Location Address Fax Number:
707-765-7495
Provider Enumeration Date:
05/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2471C3402X , with the licence number:  358321 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com