MEDICARE: BOGGS VENTURES, 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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1659186732
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOGGS VENTURES, LLC

Provider Business Mailing Address
First Line	:	1250 HIGHWAY 77
Second Line	:
City	:	SOUTHSIDE
State	:	AL
Zip	:	35907-0405
Country	:	US
Telephone Number	:	205-503-3668
Fax Number	:

Provider Business Practice Location Address
First Line	:	1250 HIGHWAY 77
Second Line	:
City	:	SOUTHSIDE
State	:	AL
Zip	:	35907-0405
Country	:	US
Telephone Number	:	205-503-3668
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MR. TRACY BOGGS
Credential	:
Telephone Number	:	205-503-3668

Provider Enumeration Date	:	02/07/2025
Last Update Date	:	02/07/2025

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Directions to “BOGGS VENTURES, LLC ” Practice Location

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