MEDICARE: MARTIN S. BOHM, D.O., PLLC

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	261Q00000X	Clinic/Center		CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	44910	OTHER	CO	COLORADO STATE LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255513677
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARTIN S. BOHM, D.O., PLLC

Provider Business Mailing Address
First Line	:	2802 MADISON SQUARE DR
Second Line	:	SUITE 120
City	:	LOVELAND
State	:	CO
Zip	:	80538-3387
Country	:	US
Telephone Number	:	970-776-1950
Fax Number	:	970-776-1954

Provider Business Practice Location Address
First Line	:	2802 MADISON SQUARE DR
Second Line	:	SUITE 120
City	:	LOVELAND
State	:	CO
Zip	:	80538-3387
Country	:	US
Telephone Number	:	970-776-1950
Fax Number	:	970-776-1954

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. MARTIN SCOTT BOHM
Credential	:	D.O.
Telephone Number	:	970-776-1950

Provider Enumeration Date	:	11/27/2007
Last Update Date	:	12/03/2009

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