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NPI Code Detail

MEDICARE: ERIC BOSHEARS

MEDICARE: ERIC BOSHEARS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1311383835OTHEROHTAX ID

General Provider Information

NPI Number : 1043786056
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIC BOSHEARS
Provider Business Mailing Address
First Line : 1526 REPUBLIC ST
Second Line :
City : CINCINNATI
State : OH
Zip : 45202-7016
Country : US
Telephone Number : 513-314-2102
Fax Number :
Provider Business Practice Location Address
First Line : 1526 REPUBLIC ST
Second Line :
City : CINCINNATI
State : OH
Zip : 45202-7016
Country : US
Telephone Number : 513-314-2102
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/17/2018
Last Update Date : 10/17/2018

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Directions to “ ERIC BOSHEARS ” Practice Location

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