Provider Demographics
NPI:1306475181
Name:BOBO PRIMARY CARE PC
Entity type:Organization
Organization Name:BOBO PRIMARY CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MESKELO
Authorized Official - Middle Name:
Authorized Official - Last Name:BOBO
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:702-849-3302
Mailing Address - Street 1:5870 W HARMON AVE APT 257
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-4895
Mailing Address - Country:US
Mailing Address - Phone:720-460-1501
Mailing Address - Fax:778-769-4717
Practice Address - Street 1:304 SE HEARTHWOOD BLVD # 873933
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-7551
Practice Address - Country:US
Practice Address - Phone:702-849-3302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-03
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty