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General NPI Number Information
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NPI Number | 1639563414
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Entity Type | Organization
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Legal Business Name | PROMEDICAL SERVICES, INC.
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Dates
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Enumeration Date | 03/19/2015
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Last Update Date | 05/28/2019
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Provider Practice Location Address
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Address Line | 30 MONICA BLVD
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City | LYNCHBURG
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State | VA
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Zip | 24502-2269
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Country | US
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Telephone | 434-515-1247
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Fax |
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Provider Business Mailing Address
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Address Line | 1102 COMMERCE ST # H
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City | LYNCHBURG
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State | VA
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Zip | 24504-1719
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Country | US
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Telephone | 434-944-0304
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Fax |
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MR. LOGAN S BOSIGER
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Credential |
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Telephone | 434-851-2052
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | 0101102727
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License Number State | VA
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