Individual ProviderJohn N. BollFamily MedicineAllopathic & Osteopathic PhysiciansPractice Address740 High St, Suite 4001, Williamsport, PA 17701-3100(570) 321-2345PECOS EnrollmentThis provider is enrolled in PECOS as JOHN BOLL.Based on the most recent information from CMS, provider John N. Boll is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1073516944Provider TypeIndividualFull NameBoll, John N.TitleMr.CredentialD.O.GenderMaleSole ProprietorNoEnumeration Date5/24/2005Last Updated4/16/2021Contact InformationPractice LocationPractice Address740 High St, Suite 4001, Williamsport, PA 17701-3100Phone(570) 321-2345Fax(570) 321-2359Mailing LocationMailing Address1201 Grampian Blvd, Williamsport, PA 17701-1900PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode207Q00000XPrimaryDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicenseOS010395LPennsylvaniaCode207VX0000XDescriptionObstetrics & GynecologyAllopathic & Osteopathic PhysiciansLicenseOS010395LPennsylvaniaProvider IdentifiersIDDescriptionIssuerID64052707DescriptionMedicaidIssuerUnlistedKentuckyID1026698040001DescriptionMedicaidIssuerUnlistedPennsylvania