BOMRAY MEDICAL CLINIC; NPI #1013974864

Contact Information

BOMRAY MEDICAL CLINIC

3627 BEATTIES FORD RD
CHARLOTTE, NC 28216-3249

Phone: 704-335-0806
Fax: 704-334-2073
Website:

Specialty	Taxonomy Code	Specialty Code	Provider Type
Primary Care	261QP2300X
Clinic/Center	261Q00000X
Health Service	261QH0100X
Student Health	261QS1000X
Urgent Care	261QU0200X

Indicates primary specialty

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NPI Profile & details for BOMRAY MEDICAL CLINIC

NPI # 1013974864

LBN Legal business name BOMRAY MEDICAL CLINIC

Authorized official JERRI OLSZEWSKI - (BILLING REPRESENTATIVE)

Entity Organization

Organization subpart ¹ No

Enumeration date 04/26/2006

Last updated 07/20/2010 - About 16 years ago

Identifiers

Medicaid

890271W

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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