Provider Demographics
NPI:1619157484
Name:HEMMO A BOSSCHER, MD PA
Entity Type:Organization
Organization Name:HEMMO A BOSSCHER, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HEMMO
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOSSCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PA
Authorized Official - Phone:806-785-5700
Mailing Address - Street 1:PO BOX 6610
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79493-6610
Mailing Address - Country:US
Mailing Address - Phone:806-796-9597
Mailing Address - Fax:806-799-6908
Practice Address - Street 1:3505 22ND PL
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1315
Practice Address - Country:US
Practice Address - Phone:806-785-5700
Practice Address - Fax:806-785-6768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3995208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170407401Medicaid
TX170407401Medicaid