Healthcare Provider Details

I. General information

NPI: 1154406858
Provider Name (Legal Business Name): B.O.S.S., INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 ENCINO PL NE SUITE A-16
ALBUQUERQUE NM
87102-2612
US

IV. Provider business mailing address

801 ENCINO PL NE SUITE A-16
ALBUQUERQUE NM
87102-2612
US

V. Phone/Fax

Practice location:
  • Phone: 505-248-1338
  • Fax: 505-244-3857
Mailing address:
  • Phone: 505-248-1338
  • Fax: 505-244-3857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number96-0642OTC
License Number StateNM

VIII. Authorized Official

Name: MR. HENRY JOSEPH DREES JR.
Title or Position: PRESIDENT
Credential: OTC
Phone: 505-248-1338