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Caroline Alice Bolduc

Internal Medicine

Allopathic & Osteopathic Physicians

1100 Wilford Hall Loop Bldg 4554, Lackland Afb, TX 78236

PECOS Enrollment

This provider is enrolled in PECOS as CAROLINE BOLDUC.

Based on the most recent information from CMS, provider Caroline Alice Bolduc is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 12:57 PM.

Profile Details

Provider ID
1780943035
Provider Type
Individual
Full Name
Bolduc, Caroline Alice
Title
Mrs.
Credential
D.O.

Gender
Female
Sole Proprietor
Yes
Enumeration Date
5/7/2012
Last Updated
6/5/2018

Contact Information

Practice Location

1100 Wilford Hall Loop Bldg 4554, Lackland Afb, TX 78236

(210) 292-5077

(210) 292-7868

Mailing Location

1100 Wilford Hall Loop Bldg 4554, Lackland Afb, TX 78236-5638

(210) 292-5077

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 207R00000X Primary	Description Internal Medicine Allopathic & Osteopathic Physicians	License 0102203656 Virginia

Caroline Alice Bolduc

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

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