Healthcare Provider Details

I. General information

NPI: 1154225183
Provider Name (Legal Business Name): ALEC BOMSKE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10506B MONTGOMERY RD # 504
MONTGOMERY OH
45242-4402
US

IV. Provider business mailing address

10506B MONTGOMERY RD # 504
MONTGOMERY OH
45242-4402
US

V. Phone/Fax

Practice location:
  • Phone: 513-745-9993
  • Fax: 513-852-1483
Mailing address:
  • Phone: 513-745-9993
  • Fax: 513-852-1483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number0043579
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: