MEDICARE: HAROLD J.P. VAN BOSSE MD

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	207XP3100X	Pediatric Orthopaedic Surgery Physician	MD434500	PA
2	207XP3100X	Pediatric Orthopaedic Surgery Physician	200545	NY
3	207XP3100X	Pediatric Orthopaedic Surgery Physician	2022040078	MO

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730176678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAROLD J.P. VAN BOSSE MD

Provider Business Mailing Address
First Line	:	1465 S GRAND BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63104-1003
Country	:	US
Telephone Number	:	314-977-4102
Fax Number	:

Provider Business Practice Location Address
First Line	:	1465 S GRAND BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63104-1003
Country	:	US
Telephone Number	:	314-977-4102
Fax Number	:

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

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	11/02/2022

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