Provider Demographics
NPI:1093074379
Name:DOCTORS BOSE AND BOSE LLC
Entity Type:Organization
Organization Name:DOCTORS BOSE AND BOSE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:BOSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-470-1063
Mailing Address - Street 1:1800 WATERS RIDGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630
Mailing Address - Country:US
Mailing Address - Phone:812-470-1063
Mailing Address - Fax:812-490-7144
Practice Address - Street 1:1800 WATERS RIDGE DR
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-8085
Practice Address - Country:US
Practice Address - Phone:812-470-1063
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-08
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060931A261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center