1841072964 NPI number — REGINALD JUSTIN BOWSER PEER RECOVERY

Table of content: REGINALD JUSTIN BOWSER PEER RECOVERY (NPI 1841072964)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841072964 NPI number — REGINALD JUSTIN BOWSER PEER RECOVERY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOWSER
Provider First Name:
REGINALD
Provider Middle Name:
JUSTIN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PEER RECOVERY
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BOWSER
Provider Other First Name:
REGINALD
Provider Other Middle Name:
JUSTIN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1841072964
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2225 MAPLEWOOD AVE APT 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45219-2920
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4400 EASTON CMNS STE 125
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43219-6223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-900-2207
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/16/2023

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: 175T00000X , with the licence number:  APS.004424 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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