Provider Demographics
NPI:1952360331
Name:BOMBENGER, JAMES JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:JOHN
Last Name:BOMBENGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E GROVER ST
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-3917
Mailing Address - Country:US
Mailing Address - Phone:704-487-3131
Mailing Address - Fax:919-477-5474
Practice Address - Street 1:201 E GROVER ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3917
Practice Address - Country:US
Practice Address - Phone:704-487-3131
Practice Address - Fax:919-477-5474
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC16518OtherBLUE CROSS
NC8916518Medicaid
NC8916518Medicaid
NC211982CMedicare PIN