Provider Demographics
NPI:1952310963
Name:BOGER ENTERPRISES INC
Entity Type:Organization
Organization Name:BOGER ENTERPRISES INC
Other - Org Name:BOGERS SHOES INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:W
Authorized Official - Last Name:BOGER
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:904-356-0459
Mailing Address - Street 1:845 BLANDING BLVD
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-8947
Mailing Address - Country:US
Mailing Address - Phone:904-356-0459
Mailing Address - Fax:
Practice Address - Street 1:845 BLANDING BLVD
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-8947
Practice Address - Country:US
Practice Address - Phone:904-356-0459
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPED179332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL028730000Medicaid
FL671169396Medicaid
FL028730000Medicaid
0723400001Medicare ID - Type Unspecified