| Name: | Boswell Family Medicine, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 15 Nov 2004 (20 years ago) (Companies founded in November 2004) |
| Entity Number: | 000-457-423 |
| Register Number: | 000457423 |
| ZIP code: | 35503 (Companies in Walker, 35503) |
| County: | Walker |
| Place of Formation: | Walker County |
| Principal Address: | JASPER, AL |
| Registered Office Street Address: | 1325 HWY 195JASPER, AL 35503 |
Activities
MEDICINE PRACTICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1174718464 | 2007-09-10 | 2007-09-10 | 1325 HIGHWAY 195, JASPER, AL, 355036461, US | 1325 HIGHWAY 195, JASPER, AL, 355036461, US | |||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 205-302-0284 |
| Fax | 2053020252 |
Authorized person
| Name | DR. SCOTT HULL BOSWELL |
| Role | PRESIDENT/OWNER |
| Phone | 2053020284 |
Taxonomy
| Taxonomy Code | 207QA0000X - Adolescent Medicine (Family Medicine) Physician |
| License Number | 16975 |
| State | AL |
| Is Primary | No |
| Taxonomy Code | 207QA0401X - Addiction Medicine (Family Medicine) Physician |
| License Number | 16975 |
| State | AL |
| Is Primary | No |
| Taxonomy Code | 207QA0505X - Adult Medicine Physician |
| License Number | 16975 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS & BLUE SHIELD |
| Number | 51029911 |
| State | AL |
| Name | Role |
|---|---|
| BOSWELL, SCOTT H | Member |
| Name | Role |
|---|---|
| BOSWELL, SCOTT H | Agent |
Date of last update: 13 Aug 2024
Sources: Alabama Secretary of State
