Provider Demographics
NPI:1902074941
Name:RICHARD G BOWLING
Entity type:Organization
Organization Name:RICHARD G BOWLING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-729-3668
Mailing Address - Street 1:3133 SABA LN
Mailing Address - Street 2:
Mailing Address - City:PORT NECHES
Mailing Address - State:TX
Mailing Address - Zip Code:77651-5421
Mailing Address - Country:US
Mailing Address - Phone:409-729-3668
Mailing Address - Fax:409-729-3670
Practice Address - Street 1:3133 SABA LN
Practice Address - Street 2:
Practice Address - City:PORT NECHES
Practice Address - State:TX
Practice Address - Zip Code:77651-5421
Practice Address - Country:US
Practice Address - Phone:409-729-3668
Practice Address - Fax:409-729-3670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1304332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX018836901Medicaid
TX018836901Medicaid
U53875Medicare UPIN
00U60XMedicare PIN