1346241601 NPI number — DR. JENEE LEE BOWMAN MD

Table of content: DR. REBECCA K BURGER MD (NPI 1376705624)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346241601 NPI number — DR. JENEE LEE BOWMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOWMAN
Provider First Name:
JENEE
Provider Middle Name:
LEE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1346241601
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/06/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2000 PERIMETER PARK DR STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORRISVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27560-8442
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
984-215-4110
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1041 NOELL LN
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
ROCKY MOUNT
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27804-2058
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-451-2700
Provider Business Practice Location Address Fax Number:
252-451-7939
Provider Enumeration Date:
08/09/2005

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: 207RC0200X , with the licence number:  20020152 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: 200201052 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 891327K , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1327K . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 0402332 . This is a "UNITED HEALTH CARE ID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: C04447 . This is a "MEDCOST ID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1142292 . This is a "FIRST HEALTH INS. ID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 2180669 . This is a "AETNA ID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8443061 . This is a "CIGNA INS. ID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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