MEDICARE: BOSCH NUTRITION LLC

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	133V00000X	Registered Dietitian	LD-D-10177915	OR

General Provider Information

NPI Number	:	1568910321
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOSCH NUTRITION LLC

Provider Business Mailing Address
First Line	:	2455 FIELDCRESS RD
Second Line	:
City	:	EUGENE
State	:	OR
Zip	:	97403-3255
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2455 FIELDCRESS RD
Second Line	:
City	:	EUGENE
State	:	OR
Zip	:	97403-3255
Country	:	US
Telephone Number	:	541-505-7758
Fax Number	:

Authorized Official
Title or Position	:	REGISTERED DIETITIAN
Name	:	MR. THOMAS BOSCH
Credential	:
Telephone Number	:	541-844-7489

Provider Enumeration Date	:	09/21/2016
Last Update Date	:	09/21/2016

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