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Contact Information

CHAD A BOULWARE
1102 W 32ND ST.
JOPLIN, MO64804
 Phone: 417-347-1111
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Emergency Medicine

207P00000X 93 Physician/Emergency Medicine
Indicates primary specialty

NPI Profile & details for CHAD A BOULWARE · (Male)

NPI Number 1922115310
Status Active
Credentials
Entity Individual
Enumeration date 08/23/2006
Last updated 10/30/2023 - About 3 years ago
Sole proprietor 1 No
Identifiers
  • MO License # 2004030781
  • KS Medicaid 200303960A
  • OK Medicaid 100710630J
Hospital affiliation(s)
  • FREEMAN HEALTH SYSTEM - FREEMAN WEST - (Acute Care)
    1102 WEST 32ND STREET
    JOPLIN, MO 64804
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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