Provider Demographics
NPI:1013242965
Name:BOWERMAN, LLC
Entity Type:Organization
Organization Name:BOWERMAN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-290-7542
Mailing Address - Street 1:PO BOX 95435
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73143-5435
Mailing Address - Country:US
Mailing Address - Phone:405-290-7542
Mailing Address - Fax:405-290-7576
Practice Address - Street 1:500 N WALKER AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-1619
Practice Address - Country:US
Practice Address - Phone:405-290-7542
Practice Address - Fax:405-290-7576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-10
Last Update Date:2009-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health