Provider Demographics
NPI:1720121189
Name:JOHN MARK BOWERS
Entity Type:Organization
Organization Name:JOHN MARK BOWERS
Other - Org Name:BELEW & RAY DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:BOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-285-5433
Mailing Address - Street 1:470 US HIGHWAY 51 BYP W
Mailing Address - Street 2:
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-1957
Mailing Address - Country:US
Mailing Address - Phone:731-285-5433
Mailing Address - Fax:731-285-1770
Practice Address - Street 1:470 US HIGHWAY 51 BYP W
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-1957
Practice Address - Country:US
Practice Address - Phone:731-285-5433
Practice Address - Fax:731-285-1770
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHN MARK BOWERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-15
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1454353Medicaid
1317660001Medicare NSC