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General NPI Number Information
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NPI Number | 1609829670
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Entity Type | Organization
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Legal Business Name | MEDICAL ASSOCIATES OF BOSWELL
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 05/14/2008
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Provider Practice Location Address
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Address Line | 136 S PINE AVE
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City | STOYSTOWN
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State | PA
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Zip | 15563-6002
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Country | US
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Telephone | 814-893-5568
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Fax | 814-893-5989
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Provider Business Mailing Address
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Address Line | 430 STONYCREEK ST
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City | BOSWELL
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State | PA
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Zip | 15531-1024
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Country | US
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Telephone | 814-893-5568
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Fax | 814-893-5989
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Authorized Official
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Title or Position | PRESIDENT
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Name | WILLILAM O. THOMPSON
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Credential | M.D.
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Telephone | 814-893-5568
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD041994E
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | MD041994E
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License Number State | PA
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