Provider Demographics
NPI:1013272848
Name:JULIA ANNE BOWLIN MD
Entity Type:Organization
Organization Name:JULIA ANNE BOWLIN MD
Other - Org Name:VERSAILLES MEDICAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:HANDSHOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-526-3271
Mailing Address - Street 1:10484 KLEY RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:VERSAILLES
Mailing Address - State:OH
Mailing Address - Zip Code:45380-9561
Mailing Address - Country:US
Mailing Address - Phone:937-526-3271
Mailing Address - Fax:937-526-5270
Practice Address - Street 1:10484 KLEY RD
Practice Address - Street 2:SUITE A
Practice Address - City:VERSAILLES
Practice Address - State:OH
Practice Address - Zip Code:45380-9561
Practice Address - Country:US
Practice Address - Phone:937-526-3271
Practice Address - Fax:937-526-5270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35067418207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0792982Medicare PIN