Provider Demographics
NPI:1043344690
Name:PATRICK W BOZARTH
Entity Type:Organization
Organization Name:PATRICK W BOZARTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:W
Authorized Official - Last Name:BOZARTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-233-9762
Mailing Address - Street 1:227 N 9TH ST
Mailing Address - Street 2:
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829-3815
Mailing Address - Country:US
Mailing Address - Phone:906-233-9762
Mailing Address - Fax:906-233-9763
Practice Address - Street 1:227 N 9TH ST
Practice Address - Street 2:
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-3815
Practice Address - Country:US
Practice Address - Phone:906-233-9762
Practice Address - Fax:906-233-9763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0B11006OtherBCBSM
MI0N70060Medicare PIN
WI000086709Medicare PIN
MI0B11006OtherBCBSM