MEDICARE: ANTOINETTE BOSTON

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	246RP1900X	Phlebotomy Technician	PTC-1581	TN
2	343900000X	Non-emergency Medical Transport (VAN)		TN

General Provider Information

NPI Number	:	1275872418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTOINETTE BOSTON

Provider Business Mailing Address
First Line	:	PO BOX 1871
Second Line	:
City	:	CORDOVA
State	:	TN
Zip	:	38088-1871
Country	:	US
Telephone Number	:	662-404-4052
Fax Number	:	901-584-0282

Provider Business Practice Location Address
First Line	:	1138 N GERMANTOWN PKWY # 101-379
Second Line	:
City	:	CORDOVA
State	:	TN
Zip	:	38016-5872
Country	:	US
Telephone Number	:	662-404-4052
Fax Number	:	901-584-0282

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

Provider Enumeration Date	:	02/07/2013
Last Update Date	:	05/31/2024

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Directions to “ ANTOINETTE BOSTON ” Practice Location

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