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General NPI Number Information
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NPI Number | 1174718464
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Entity Type | Organization
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Legal Business Name | BOSWELL FAMILY MEDICINE
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Dates
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Enumeration Date | 09/10/2007
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Last Update Date | 09/10/2007
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Provider Practice Location Address
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Address Line | 1325 HIGHWAY 195
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City | JASPER
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State | AL
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Zip | 35503-6461
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Country | US
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Telephone | 205-302-0284
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Fax | 205-302-0252
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Provider Business Mailing Address
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Address Line | 1325 HIGHWAY 195
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City | JASPER
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State | AL
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Zip | 35503-6461
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Country | US
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Telephone | 205-302-0284
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Fax | 205-302-0252
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. SCOTT HULL BOSWELL
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Credential | M.D.
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Telephone | 205-302-0284
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0000X
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Taxonomy Name | Adolescent Medicine (Family Medicine) Physician
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License Number | 16975
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | 16975
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License Number State | AL
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Taxonomy #3
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | 16975
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License Number State | AL
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