Provider Demographics
NPI:1710761283
Name:BOGER ENTERPRISES, INC
Entity Type:Organization
Organization Name:BOGER ENTERPRISES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-356-0459
Mailing Address - Street 1:1014 PARK ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-3908
Mailing Address - Country:US
Mailing Address - Phone:904-356-0459
Mailing Address - Fax:904-356-0450
Practice Address - Street 1:624 GOODWIN ST UNIT 8
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-3214
Practice Address - Country:US
Practice Address - Phone:904-356-0459
Practice Address - Fax:904-356-0450
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOGER ENTERPRISES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017819100Medicaid