Healthcare Provider Details

I. General information

NPI: 1144574922
Provider Name (Legal Business Name): BOYETT HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2012
Last Update Date: 11/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2131 MILITARY ST S
HAMILTON AL
35570-6651
US

IV. Provider business mailing address

PO BOX 747
HAMILTON AL
35570-0747
US

V. Phone/Fax

Practice location:
  • Phone: 205-921-0893
  • Fax: 205-921-6723
Mailing address:
  • Phone: 205-921-0893
  • Fax: 205-921-6723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4622
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. BRENT EDGEWORTH BOYETT
Title or Position: OWNER
Credential: D.M.D., D.O.
Phone: 205-921-0893