Provider Demographics
NPI:1174522361
Name:BOSWELL, SCOTT HULL (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:HULL
Last Name:BOSWELL
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2905 LONG RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35504-9156
Mailing Address - Country:US
Mailing Address - Phone:205-275-9075
Mailing Address - Fax:205-302-0252
Practice Address - Street 1:2905 LONG RIDGE DR
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35504-9156
Practice Address - Country:US
Practice Address - Phone:205-275-9075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16975207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51029911OtherBLUE CROSS NUMBER
AL000029911Medicaid
ALC25985Medicare UPIN
AL000029911Medicare ID - Type UnspecifiedMEDICARE NUMBER