Healthcare Provider Details

I. General information

NPI: 1801156401
Provider Name (Legal Business Name): BOSA MEDICAL COMPANY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2012
Last Update Date: 01/27/2026
Certification Date: 01/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4921 E BELL RD STE 204
SCOTTSDALE AZ
85254-6002
US

IV. Provider business mailing address

4921 E BELL RD STE 204
SCOTTSDALE AZ
85254-6002
US

V. Phone/Fax

Practice location:
  • Phone: 602-753-9403
  • Fax: 602-753-9453
Mailing address:
  • Phone: 602-753-9403
  • Fax: 602-753-9453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number0701
License Number StateAZ
# 5
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0695
License Number StateAZ

VIII. Authorized Official

Name: KATHY HOLT
Title or Position: BILLING MANAGER
Credential:
Phone: 928-477-2238