Provider Demographics
NPI:1174718464
Name:BOSWELL FAMILY MEDICINE
Entity type:Organization
Organization Name:BOSWELL FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:HULL
Authorized Official - Last Name:BOSWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-302-0284
Mailing Address - Street 1:1325 HIGHWAY 195
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35503-6461
Mailing Address - Country:US
Mailing Address - Phone:205-302-0284
Mailing Address - Fax:205-302-0252
Practice Address - Street 1:1325 HIGHWAY 195
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35503-6461
Practice Address - Country:US
Practice Address - Phone:205-302-0284
Practice Address - Fax:205-302-0252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16975207QA0000X, 207QA0401X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent MedicineGroup - Single Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51029911OtherBLUE CROSS & BLUE SHIELD
C25985Medicare PIN