Provider Demographics
NPI:1588905301
Name:JOSEPH M BOWEN MD PC DME
Entity type:Organization
Organization Name:JOSEPH M BOWEN MD PC DME
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:BOWEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-457-7075
Mailing Address - Street 1:PO BOX 3482
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83877-3482
Mailing Address - Country:US
Mailing Address - Phone:208-209-6170
Mailing Address - Fax:208-209-6169
Practice Address - Street 1:1296 E POLSTON AVE
Practice Address - Street 2:SUITE B
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-5217
Practice Address - Country:US
Practice Address - Phone:208-457-7075
Practice Address - Fax:208-457-7076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-04
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies