MEDICARE: DR. SCOTT HULL BOSWELL M.D., M.P.H.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	16975	AL
2	208D00000X	General Practice Physician	16975	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51029911	OTHER	AL	BLUE CROSS NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174522361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT HULL BOSWELL M.D., M.P.H.

Provider Business Mailing Address
First Line	:	2905 LONG RIDGE DR
Second Line	:
City	:	JASPER
State	:	AL
Zip	:	35504-9156
Country	:	US
Telephone Number	:	205-275-9075
Fax Number	:	205-302-0252

Provider Business Practice Location Address
First Line	:	2905 LONG RIDGE DR
Second Line	:
City	:	JASPER
State	:	AL
Zip	:	35504-9156
Country	:	US
Telephone Number	:	205-275-9075
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	11/25/2019

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