Provider Demographics
NPI:1518914522
Name:BOWMAN MEDICAL
Entity Type:Organization
Organization Name:BOWMAN MEDICAL
Other - Org Name:BOWMAN MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:DARYL
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-654-5525
Mailing Address - Street 1:1200 INDUSTRIAL RD
Mailing Address - Street 2:SUITE 16
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-4129
Mailing Address - Country:US
Mailing Address - Phone:650-654-5525
Mailing Address - Fax:650-654-5518
Practice Address - Street 1:1200 INDUSTRIAL RD
Practice Address - Street 2:SUITE 16
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-4129
Practice Address - Country:US
Practice Address - Phone:650-654-5525
Practice Address - Fax:650-654-5518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102815332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME02299FMedicaid
CADME02299FMedicaid