Provider Demographics
NPI:1083650402
Name:J.A. BOWE, M.D., P.C.
Entity Type:Organization
Organization Name:J.A. BOWE, M.D., P.C.
Other - Org Name:GREEN HILLS MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOWE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:660-359-3939
Mailing Address - Street 1:3300 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:MO
Mailing Address - Zip Code:64683-9579
Mailing Address - Country:US
Mailing Address - Phone:660-359-3939
Mailing Address - Fax:660-359-4372
Practice Address - Street 1:3300 E 10TH ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MO
Practice Address - Zip Code:64683-9579
Practice Address - Country:US
Practice Address - Phone:660-359-3939
Practice Address - Fax:660-359-4372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
MO2002014049261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO263851Medicare Oscar/Certification