Richard S. Boss, M.D.
Individual provider Active NPI Family Medicine Physician · Fremont, MI
NPI 1366492852 · NPPES record last updated Mar 10, 2014
Key facts
- NPI
- 1366492852
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 039762 (MI)
- Practice address
- 230 W Oak St
Suite 201
Fremont, MI 49412-1575 - Phone
- (231) 924-4200
- Fax
- (231) 924-4064
- NPI assigned
- May 12, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 039762 | MI | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Newaygo County General Hospital Association | Past | Accepting new patients | |
| Saint Mary'S Health Services | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 039762 | MI | Yes |
Addresses
Primary practice location
230 W Oak St
Suite 201
Fremont, MI 49412-1575
Mailing address
100 Michigan St NE
MC 845
Grand Rapids, MI 49503-2560
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All providers in Fremont, MI · Family Medicine Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 10, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.