Healthcare Provider Details

I. General information

NPI: 1174718464
Provider Name (Legal Business Name): BOSWELL FAMILY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 09/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 HIGHWAY 195
JASPER AL
35503-6461
US

IV. Provider business mailing address

1325 HIGHWAY 195
JASPER AL
35503-6461
US

V. Phone/Fax

Practice location:
  • Phone: 205-302-0284
  • Fax: 205-302-0252
Mailing address:
  • Phone: 205-302-0284
  • Fax: 205-302-0252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number16975
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number16975
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number16975
License Number StateAL

VIII. Authorized Official

Name: DR. SCOTT HULL BOSWELL
Title or Position: PRESIDENT/OWNER
Credential: M.D.
Phone: 205-302-0284