MR. RICHARD C BOLEWARE (NPI# 1194909069) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194909069 |
| Entity Type | Individual |
| Full Name | MR. RICHARD C BOLEWARE |
| Credential | CP |
| Practice Address |
2 Old River Pl Ste D Jackson MS 39202-3435 |
| Practice Telephone | 6019441130 |
| Practice Fax Number | 6013557476 |
| Mailing Telephone | 6019441130 |
| Mailing Fax Number | 6013557476 |
| Enumeration Date | 2007-12-27 |
| Last Update Date | 2015-05-19 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 224P00000X | Prosthetist | CP003226 | MS | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Street Address |
2 OLD RIVER PL STE D |
| City | JACKSON |
| State | MS |
| Zip Code | 39202-3435 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679916183 | Zachary Douglas Myrick | Orthotist | 2 Old River Pl Ste D, Jackson, MS 39202-3435 | 2013-04-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982234183 | Eva Mackenzie Carmody | Physician Assistant | 1190 N State St Suite 502, Jackson, MS 39202 | 2020-01-16 |
| 1750868691 | Katherine Walters | Nurse Practitioner | 501 Marshall St., Suite 400, Jackson, MS 39202 | 2018-07-24 |
| 1932638749 | Tylan Lee | Social Worker | 860 East River Place Suite 100, Jackson, MS 39202 | 2017-06-06 |
| 1417314725 | Euna Jyles | Counselor | 860 E River Pl, Jackson, MS 39202 | 2016-01-19 |
| 1255712048 | Edward Jonathan Breight | Specialist/Technologist | 1325 East Fortication Street, Jackson, MS 39202 | 2015-06-17 |
| 1881037703 | Kara Spinks Logan | Surgery | 1190 N State St Ste 502, Jackson, MS 39202 | 2013-04-10 |
| 1477876530 | Mick Inc. | Technician | 334 Josanna Street, Suite #209, Jackson, MS 39202 | 2010-03-03 |
| 1073724910 | Paul Frederic Dare | Anesthesiology | 1151 North State St., Suite 311, Jackson Anesthesia Associates, Jackson, MS 39202 | 2007-05-24 |
| 1225247703 | Lynn Kincannon Holland | Counselor | 911 Manship Street, Unit A, Jackson, MS 39202 | 2007-05-22 |
| 1457568149 | Incare Inc | Pulmonary Function Technologist | 1151 North State St, Suite 406, Jackson, MS 39202 | 2007-05-16 |
| Find all providers in zip 39202 | ||||
| Taxonomy Code | 224P00000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Prosthetist |
| A health care professional who is specifically educated and trained to manage comprehensive prosthetic patient care for individuals who have sustained complete or partial limb loss or absence. Prosthetists assess specific patient needs, formulate an appropriate treatment plan, implement the treatment plan and provide follow-up care. |
| Notes: Source: American Board for Certification in Orthotics, Prosthetics, and Pedorthics, Inc. [7/1/2010: modified, 7/1/2013: modified] Additional Resources: American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc., www.abcop.org and Board of Certification/Accreditation, International, www.bocusa.org. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427042134 | Buckner Prosthetic and Orthotic Laboratories Inc. | Prosthetist | 2 Old River Pl, Suite D, Jackson, MS 39202-3435 | 2005-09-08 |
| 1871887653 | Stephen James Singleton | Prosthetist | 2 Old River Pl, Suite D, Jackson, MS 39202-3435 | 2011-06-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285247783 | Jay Michael Rubenstein | Prosthetist | 3004 Bienville Blvd Ste 1, Ocean Springs, MS 39564-4370 | 2020-08-25 |
| 1750906301 | Denisha Louise Williams | Prosthetist | 828 Pass Rd Ste C, Gulfport, MS 39501-6437 | 2020-06-10 |
| 1538795364 | Faithful Limbs Prosthetics | Prosthetist | 114 Herring Dr, Raymond, MS 39154-9646 | 2020-03-12 |
| 1801428438 | Kimberly Toler | Prosthetist | 8225 Barberry Pl, Southaven, MS 38671-4203 | 2020-02-11 |
| 1194287953 | Brianna Marshall | Prosthetist | 100 Shelby Street, Beulah, MS 38726 | 2019-04-02 |
| 1386106375 | Nicole Clark | Prosthetist | 100 N Burke Ave, Long Beach, MS 39560-4605 | 2019-04-01 |
| 1023576972 | Synterika Shanta Welch | Prosthetist | 7164 Hacks Cross Rd, Olive Branch, MS 38654-4472 | 2019-03-11 |
| 1295203602 | Joanetta Marie Williams | Prosthetist | 806 S 28th Ave, Hattiesburg, MS 39402-2601 | 2018-11-05 |
| 1174888457 | Philip Anthony Bickert | Prosthetist | 2106s Tate St, Corinth, MS 38834-7913 | 2012-07-12 |
| 1285848846 | Douglas Santrell Banks | Prosthetist | 199 Charmant Pl, Suite 4, Ridgeland, MS 39157-4358 | 2007-05-10 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.