Organization
BOLL MEDICAL, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. M. EUGENE WEEMS (PRESIDENT)
(304) 345-2944
Entity
Organization
Contact information
Practice address
1223 WASHINGTON ST E, CHARLESTON, WV 25301-1814
(304) 345-2944
(304) 345-2957
Mailing address
PO BOX 11810, CHARLESTON, WV 25339-1810
(304) 345-2944
(304) 345-2957
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
279779
WV
332BC3200X
Customized Equipment (DME)
279779
WV
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
279779
WV
332BX2000X
Oxygen Equipment & Supplies (DME)
279779
WV
335E00000X
Prosthetic/Orthotic Supplier
279779
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001705317
BLUE CROSS BLUE SHIELD PR
WV
05
—
0147067000
—
WV
01
—
041242100
FEDERAL BLACK LUNG
WV
Enumeration date
11/03/2005
Last updated
01/14/2011
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