Healthcare Provider Details

I. General information

NPI: 1114127289
Provider Name (Legal Business Name): RODNEY JEROME BOSWELL CSFA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2007
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W RANDOL MILL RD
ARLINGTON TX
76012-2504
US

IV. Provider business mailing address

PO BOX 163124
FORT WORTH TX
76161-3124
US

V. Phone/Fax

Practice location:
  • Phone: 817-888-7577
  • Fax:
Mailing address:
  • Phone: 817-888-7577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number82243
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number128366
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: