Provider Demographics
NPI:1255358800
Name:ELISABETH A. BOSSINGHAM, M.D., INC
Entity type:Organization
Organization Name:ELISABETH A. BOSSINGHAM, M.D., INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELISABETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOSSINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-622-0800
Mailing Address - Street 1:1827 S COURT ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-5469
Mailing Address - Country:US
Mailing Address - Phone:559-622-0800
Mailing Address - Fax:559-622-0801
Practice Address - Street 1:1827 S COURT ST
Practice Address - Street 2:SUITE F
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-5469
Practice Address - Country:US
Practice Address - Phone:559-622-0800
Practice Address - Fax:559-622-0801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG69388208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
BH2464965OtherDEA