Provider Demographics
NPI:1508810961
Name:BOSLEY, LOIS J (DO)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:J
Last Name:BOSLEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:304-675-4498
Mailing Address - Fax:304-675-8182
Practice Address - Street 1:2605 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT
Practice Address - State:WV
Practice Address - Zip Code:25550-1615
Practice Address - Country:US
Practice Address - Phone:304-675-4498
Practice Address - Fax:304-675-8182
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35.005706207Q00000X
WV1302207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
001714063OtherMOUNTAIN STATE BCBS
OH0934921OtherMOLINA MEDICAID
OH000000185204OtherUNISON MEDICAID
OH310917085160OtherCARESOURCE MEDICAID
000000006633OtherANTHEM BCBS
WV0053788000Medicaid
080048368OtherRR MEDICARE
001714063OtherMOUNTAIN STATE BCBS
OH310917085160OtherCARESOURCE MEDICAID