MEDICARE: LINDA RITA BOGGS PA-C

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
1	363AM0700X	Medical Physician Assistant	00005	WV
2	363AM0700X	Medical Physician Assistant	0010-05055	NC

General Provider Information

NPI Number	:	1437192127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA RITA BOGGS PA-C

Provider Business Mailing Address
First Line	:	906 N US 421 HWY
Second Line	:
City	:	CLINTON
State	:	NC
Zip	:	28328-0410
Country	:	US
Telephone Number	:	910-592-1462
Fax Number	:

Provider Business Practice Location Address
First Line	:	906 N US 421 HWY
Second Line	:
City	:	CLINTON
State	:	NC
Zip	:	28328-0410
Country	:	US
Telephone Number	:	910-592-1462
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	07/08/2014

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