MEDICARE: DOUGLAS GLENN BOSTICK

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
1	343900000X	Non-emergency Medical Transport (VAN)		NC

General Provider Information

NPI Number	:	1104768431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS GLENN BOSTICK

Provider Business Mailing Address
First Line	:	384 HIGHLAND DR
Second Line	:
City	:	LEXINGTON
State	:	NC
Zip	:	27292-9354
Country	:	US
Telephone Number	:	252-695-5277
Fax Number	:	252-227-4135

Provider Business Practice Location Address
First Line	:	384 HIGHLAND DR
Second Line	:
City	:	LEXINGTON
State	:	NC
Zip	:	27292-9354
Country	:	US
Telephone Number	:	252-695-5277
Fax Number	:	252-227-4135

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2026
Last Update Date	:	04/07/2026

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Directions to “ DOUGLAS GLENN BOSTICK ” Practice Location

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