MEDICARE: BOOMER MEDICAL CENTER, INC.

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	261QR1300X	Rural Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609942820
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOOMER MEDICAL CENTER, INC.

Provider Business Mailing Address
First Line	:	PO BOX 238
Second Line	:	156 BOOMER COMMUNITY CENTER RD
City	:	BOOMER
State	:	NC
Zip	:	28606-9199
Country	:	US
Telephone Number	:	336-921-2273
Fax Number	:	336-921-2405

Provider Business Practice Location Address
First Line	:	156 BOOMER COMMUNITY CENTER RD
Second Line	:
City	:	BOOMER
State	:	NC
Zip	:	28606-9199
Country	:	US
Telephone Number	:	336-921-2273
Fax Number	:	336-921-2405

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. DEBORAH NEWMAN PIERCE
Credential	:
Telephone Number	:	336-921-2273

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	04/16/2008

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