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General NPI Number Information
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NPI Number | 1851429971
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Entity Type | Organization
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Legal Business Name | BOLTON CLINIC, PLLC
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 04/16/2008
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Provider Practice Location Address
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Address Line | 2001 AIRPORT RD N SUITE 204
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City | FLOWOOD
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State | MS
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Zip | 39232-8827
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Country | US
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Telephone | 601-932-3191
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Fax | 601-936-7193
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Provider Business Mailing Address
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Address Line | 115 W MADISON ST
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City | BOLTON
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State | MS
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Zip | 39041
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Country | US
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Telephone | 601-866-7723
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Fax | 601-866-7773
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. WILLIAM F KROOSS II
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Credential | MD
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Telephone | 601-932-3191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R652075
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License Number State | MS
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