Healthcare Provider Details

I. General information

NPI: 1750383311
Provider Name (Legal Business Name): THE BOWEN MEDICAL COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12651 ZENITH AVE SUITE 101
BURNSVILLE MN
55337-1772
US

IV. Provider business mailing address

11891 168TH ST W
LAKEVILLE MN
55044-7796
US

V. Phone/Fax

Practice location:
  • Phone: 952-808-7761
  • Fax: 952-808-7762
Mailing address:
  • Phone: 952-898-7531
  • Fax: 952-898-7532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. BRIAN THOMAS BOWEN JR.
Title or Position: PRSIDENT
Credential: C.PED.
Phone: 612-819-1690