Provider Demographics
NPI:1043786056
Name:BOSHEARS, ERIC
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:BOSHEARS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1526 REPUBLIC ST
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202-7016
Mailing Address - Country:US
Mailing Address - Phone:513-314-2102
Mailing Address - Fax:
Practice Address - Street 1:1526 REPUBLIC ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-7016
Practice Address - Country:US
Practice Address - Phone:513-314-2102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-17
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH311383835OtherTAX ID