MEDICARE: RICHARD G BOWLING

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	332B00000X	Durable Medical Equipment & Medical Supplies	1304	TX

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	:	1902074941
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHARD G BOWLING

Provider Business Mailing Address
First Line	:	3133 SABA LN
Second Line	:
City	:	PORT NECHES
State	:	TX
Zip	:	77651-5421
Country	:	US
Telephone Number	:	409-729-3668
Fax Number	:	409-729-3670

Provider Business Practice Location Address
First Line	:	3133 SABA LN
Second Line	:
City	:	PORT NECHES
State	:	TX
Zip	:	77651-5421
Country	:	US
Telephone Number	:	409-729-3668
Fax Number	:	409-729-3670

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. MARY BETH BOWLING
Credential	:
Telephone Number	:	409-729-3668

Provider Enumeration Date	:	02/12/2008
Last Update Date	:	06/01/2011

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