Healthcare Provider Details

I. General information

NPI: 1083738181
Provider Name (Legal Business Name): BOZARTH ORTHOPAEDIC AND OCCUPATIONAL MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 05/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8207 NORTHWOODS DR
LINCOLN NE
68505-2093
US

IV. Provider business mailing address

PO BOX 67250
LINCOLN NE
68506-7250
US

V. Phone/Fax

Practice location:
  • Phone: 402-466-0555
  • Fax: 402-488-0743
Mailing address:
  • Phone: 402-328-8833
  • Fax: 402-328-2921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DENNIS R. BOZARTH
Title or Position: PRESIDENT PHYSICIAN
Credential: M.D.
Phone: 402-466-0555