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NPI Code Detail

MEDICARE: CHANGKUOTH BOL

MEDICARE: CHANGKUOTH BOL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1374700000XTechnicianNE

General Provider Information

NPI Number : 1043168768
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHANGKUOTH BOL
Provider Business Mailing Address
First Line : 1299 FARNAM ST STE 300
Second Line :
City : OMAHA
State : NE
Zip : 68102-1857
Country : US
Telephone Number : 314-252-0093
Fax Number : 314-252-0093
Provider Business Practice Location Address
First Line : 1299 FARNAM ST STE 300
Second Line :
City : OMAHA
State : NE
Zip : 68102-1857
Country : US
Telephone Number : 314-252-0093
Fax Number : 314-252-0093
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/18/2026
Last Update Date : 03/18/2026

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Directions to “ CHANGKUOTH BOL ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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