Active NPI
Richard C Boleware, CP
- Prosthetist
- Jackson, MS
National Provider Identifier
1194909069
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthetist
- License
- CP003226
- Practice address
- 2 Old River PL Ste D
Jackson, MS 39202-3435 - Phone
- (601) 944-1130
- Fax
- (601) 355-7476
- NPI assigned
- Dec 27, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prosthetist | 224P00000X | CP003226 | MS | Primary |
Addresses
Primary practice location
2 Old River PL Ste D
Jackson, MS 39202-3435
Mailing address
2 Old River PL Ste D
Jackson, MS 39202-3435
Phone (601) 944-1130
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CP003226 | MS | MD | Prosthetist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1198713600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1431993600000",
"number": "1194909069",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2 OLD RIVER PL STE D",
"city": "JACKSON",
"state": "MS",
"postal_code": "392023435",
"telephone_number": "601-944-1130",
"fax_number": "601-355-7476"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2 OLD RIVER PL STE D",
"city": "JACKSON",
"state": "MS",
"postal_code": "392023435",
"telephone_number": "601-944-1130",
"fax_number": "601-355-7476"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOLEWARE",
"first_name": "RICHARD",
"middle_name": "C",
"name_prefix": "Mr.",
"credential": "CP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-12-27",
"last_updated": "2015-05-19",
"status": "A"
},
"taxonomies": [
{
"code": "224P00000X",
"taxonomy_group": "",
"desc": "Prosthetist",
"state": "MS",
"license": "CP003226",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jackson, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.