MEDICARE: JOHN COVINGTON BOSWELL M.D.

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	207R00000X	Internal Medicine Physician	25562	AL
2	207R00000X	Internal Medicine Physician	22843	MS
3	207RS0012X	Sleep Medicine (Internal Medicine) Physician	22843	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316991219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN COVINGTON BOSWELL M.D.

Provider Business Mailing Address
First Line	:	965 RIDGE LAKE BLVD BLDG STE 103
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38120-9401
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	255 BAPTIST BLVD STE 402
Second Line	:
City	:	COLUMBUS
State	:	MS
Zip	:	39705-2006
Country	:	US
Telephone Number	:	662-244-2550
Fax Number	:

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

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	01/27/2020

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