Provider Demographics
NPI:1144366006
Name:BOYD E. BOWMAN
Entity type:Organization
Organization Name:BOYD E. BOWMAN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BOYD
Authorized Official - Middle Name:E
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-891-8100
Mailing Address - Street 1:13701 24TH ST E
Mailing Address - Street 2:SUITE A 8
Mailing Address - City:SUMNER
Mailing Address - State:WA
Mailing Address - Zip Code:98390-9675
Mailing Address - Country:US
Mailing Address - Phone:253-891-8100
Mailing Address - Fax:253-891-8108
Practice Address - Street 1:13701 24TH ST E
Practice Address - Street 2:SUITE A 8
Practice Address - City:SUMNER
Practice Address - State:WA
Practice Address - Zip Code:98390-9675
Practice Address - Country:US
Practice Address - Phone:253-891-8100
Practice Address - Fax:253-891-8108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9038837Medicaid