Provider Demographics
NPI:1558374355
Name:ERNEST M. BOVE, M.D
Entity Type:Organization
Organization Name:ERNEST M. BOVE, M.D
Other - Org Name:MID-VERMONT UROLOGY, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:M
Authorized Official - Last Name:BOVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-775-6006
Mailing Address - Street 1:145 ALLEN ST
Mailing Address - Street 2:PO BOX 666
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4555
Mailing Address - Country:US
Mailing Address - Phone:802-775-6006
Mailing Address - Fax:802-773-4946
Practice Address - Street 1:145 ALLEN ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4555
Practice Address - Country:US
Practice Address - Phone:802-775-6006
Practice Address - Fax:802-773-4946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT42-007313208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT00006431Medicaid
VT0004692Medicare PIN
VT00006431Medicaid