Provider Demographics
NPI:1053615229
Name:NEIL BOMAR MD PLLC
Entity type:Organization
Organization Name:NEIL BOMAR MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:HORTON
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:901-737-1992
Mailing Address - Street 1:6750 POPLAR AVE
Mailing Address - Street 2:620
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38138-7438
Mailing Address - Country:US
Mailing Address - Phone:901-755-9908
Mailing Address - Fax:901-309-8784
Practice Address - Street 1:6750 POPLAR AVE
Practice Address - Street 2:620
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38138-7438
Practice Address - Country:US
Practice Address - Phone:901-755-9908
Practice Address - Fax:901-309-8784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3326060Medicaid
3326060Medicare PIN