Bostrom, Jake P

Bostrom, Jake P is an individual health care provider with primary practice located at 1520 Boiling Springs Rd , Boiling Springs SC 29316. He recently has only one registered license in Allopathic & Osteopathic Physicians / Ophthalmology, which is considered as his primary health care specialty. Bostrom, Jake P can be contacted via phone (864) 583-6381.

Contact Information

Primary practice address
1520 Boiling Springs Rd Boiling Springs SC 29316
Phone: (864) 583-6381
Fax: (864) 583-6390
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Ophthalmology 207W00000X 31615 South Carolina

Profile Details

NPI number 1295886125
LBN Legal business name Bostrom, Jake P
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 16th, 2007
Last updated Jul 9th, 2019 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1295886125 NPPES
South Carolina Other AA3955-7292 MEDICARE PTAN
South Carolina Other 31615 MEDICARE PTAN
South Carolina Other 1457384729 MEDICARE PTAN
South Carolina MEDICAID 316152 MEDICARE PTAN
South Carolina Other P01501403 MEDICARE PTAN

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