Provider Demographics
NPI:1891454328
Name:BOSTON PRIMARY CARE LLC
Entity Type:Organization
Organization Name:BOSTON PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSTON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:225-328-3181
Mailing Address - Street 1:18448 MAGNOLIA BRIDGE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:GREENWELL SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70739-4626
Mailing Address - Country:US
Mailing Address - Phone:225-256-0063
Mailing Address - Fax:225-256-0217
Practice Address - Street 1:18448 MAGNOLIA BRIDGE RD
Practice Address - Street 2:SUITE A
Practice Address - City:GREENWELL SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70739-4626
Practice Address - Country:US
Practice Address - Phone:225-256-0063
Practice Address - Fax:225-256-0217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-13
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty