Provider Demographics
NPI:1750383311
Name:THE BOWEN MEDICAL COMPANY
Entity type:Organization
Organization Name:THE BOWEN MEDICAL COMPANY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRSIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:BOWEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:CPED
Authorized Official - Phone:612-819-1690
Mailing Address - Street 1:11891 168TH ST W
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-7796
Mailing Address - Country:US
Mailing Address - Phone:952-898-7531
Mailing Address - Fax:952-898-7532
Practice Address - Street 1:12651 ZENITH AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-1772
Practice Address - Country:US
Practice Address - Phone:952-808-7761
Practice Address - Fax:952-808-7762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN5068720001Medicare NSC