MEDICARE: BOSWORTH THERAPY & CONSULTATION SERVICES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	1590	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548203730
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOSWORTH THERAPY & CONSULTATION SERVICES INC

Provider Business Mailing Address
First Line	:	3213 WEST MAIN STREET
Second Line	:	# 215
City	:	RAPID CITY
State	:	SD
Zip	:	57702
Country	:	US
Telephone Number	:	605-343-7755
Fax Number	:	605-721-8896

Provider Business Practice Location Address
First Line	:	2650 JACKSON BLVD
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702
Country	:	US
Telephone Number	:	605-343-7755
Fax Number	:	605-721-8896

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. THOMAS MATTHEW BOSWORTH
Credential	:
Telephone Number	:	605-343-7755

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	04/23/2015

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