Provider Demographics
NPI:1336336577
Name:JAMES T BOWLUS MD INC
Entity Type:Organization
Organization Name:JAMES T BOWLUS MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:T
Authorized Official - Last Name:BOWLUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-331-0443
Mailing Address - Street 1:PO BOX 3097
Mailing Address - Street 2:
Mailing Address - City:ELIDA
Mailing Address - State:OH
Mailing Address - Zip Code:45807-0097
Mailing Address - Country:US
Mailing Address - Phone:419-331-0443
Mailing Address - Fax:419-331-3137
Practice Address - Street 1:610 E KIRACOFE AVE
Practice Address - Street 2:
Practice Address - City:ELIDA
Practice Address - State:OH
Practice Address - Zip Code:45807-1034
Practice Address - Country:US
Practice Address - Phone:419-331-0443
Practice Address - Fax:419-331-3137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35036062207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH012675073OtherRAILROAD MEDICARE
OH0305146Medicaid
OH9207821Medicare PIN