Healthcare Provider Details

I. General information

NPI: 1730394040
Provider Name (Legal Business Name): ADAM SCOTT BOESTER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 10/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 W BROAD ST
COLUMBUS OH
43228-1607
US

IV. Provider business mailing address

123 W 1ST AVE APT C
COLUMBUS OH
43201-3489
US

V. Phone/Fax

Practice location:
  • Phone: 614-544-1000
  • Fax:
Mailing address:
  • Phone: 954-536-5037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberN5579
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207PH0002X
TaxonomyHospice and Palliative Medicine (Emergency Medicine) Physician
License Number58-002260
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: