MEDICARE: DR. STEPHEN J BOGAN M.D.

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	207W00000X	Ophthalmology Physician	16420	SC
2	207W00000X	Ophthalmology Physician	36496	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	16428	OTHER	SC	BCBS
2	16428	OTHER		BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	D448817495	OTHER		MC SOUTH CAROLINA
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	0860143	OTHER		UNITED HEALTH CARE
7	16428	OTHER	NC	BCBS
8	561705541	OTHER		CMS 1500
9	561705541	OTHER	NC	WORKMANS COMP
10	D44881	OTHER		FIRST HEALTH
11	561705441	OTHER		AETNA
12	S341421	OTHER		HEALTHSOURCE SC INC
13	104386	OTHER		WELLNESS PLAN
14	2109355	OTHER		MAMSI INSURANCE
15	561705541	OTHER	SC	WORKMANS COMP

General Provider Information

NPI Number	:	1942286018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN J BOGAN M.D.

Provider Business Mailing Address
First Line	:	1170 WYKE RD
Second Line	:
City	:	SHELBY
State	:	NC
Zip	:	28150-4259
Country	:	US
Telephone Number	:	704-482-6767
Fax Number	:	704-600-6232

Provider Business Practice Location Address
First Line	:	1170 WYKE RD.
Second Line	:
City	:	SHELBY
State	:	NC
Zip	:	28150-3406
Country	:	US
Telephone Number	:	704-482-6767
Fax Number	:	704-484-2507

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

Provider Enumeration Date	:	12/20/2005
Last Update Date	:	10/05/2023

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