Provider Demographics
NPI:1508007691
Name:BOLSON HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:BOLSON HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:D
Authorized Official - Last Name:OPUIYO
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:832-754-2410
Mailing Address - Street 1:1733 CARTER ST
Mailing Address - Street 2:
Mailing Address - City:WHARTON
Mailing Address - State:TX
Mailing Address - Zip Code:77488-2849
Mailing Address - Country:US
Mailing Address - Phone:979-282-8800
Mailing Address - Fax:979-282-8803
Practice Address - Street 1:1733 CARTER ST
Practice Address - Street 2:
Practice Address - City:WHARTON
Practice Address - State:TX
Practice Address - Zip Code:77488-2849
Practice Address - Country:US
Practice Address - Phone:979-282-8800
Practice Address - Fax:979-282-8803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-18
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6097207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty