Healthcare Provider Details

I. General information

NPI: 1043344690
Provider Name (Legal Business Name): PATRICK W BOZARTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 N 9TH ST
ESCANABA MI
49829-3815
US

IV. Provider business mailing address

227 N 9TH ST
ESCANABA MI
49829-3815
US

V. Phone/Fax

Practice location:
  • Phone: 906-233-9762
  • Fax: 906-233-9763
Mailing address:
  • Phone: 906-233-9762
  • Fax: 906-233-9763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name: PATRICK W BOZARTH
Title or Position: OWNER
Credential:
Phone: 906-233-9762