Provider Demographics
NPI:1659776045
Name:BOBBYBOOTCAMPS
Entity Type:Organization
Organization Name:BOBBYBOOTCAMPS
Other - Org Name:BOBBYBOOTCAMPS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:C
Authorized Official - Last Name:CRAIG
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:512-771-8609
Mailing Address - Street 1:2960 DONNELL DR
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-5709
Mailing Address - Country:US
Mailing Address - Phone:512-771-8609
Mailing Address - Fax:
Practice Address - Street 1:2960 DONNELL DR
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-5709
Practice Address - Country:US
Practice Address - Phone:512-771-8609
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT037974172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty