| Name: | Boswell Medical Services, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 30 Dec 2010 (14 years ago) |
| Entity Number: | 000-266-079 |
| Register Number: | 000266079 |
| ZIP code: | 35563 |
| County: | Marion |
| Place of Formation: | Marion County |
| Principal Address: | 621 COUNTY HIGHWAY 135GUIN, AL 35563 |
| Authorized Capital: | $1,000 |
| Paid Share Capital: | $1,000 |
Activities
MEDICAL PRACTICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1023384252 | 2012-04-02 | 2012-04-03 | PO BOX 611, GUIN, AL, 355630611, US | 1530 US HIGHWAY 43, WINFIELD, AL, 355945056, US | |||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||
| Phone | +1 205-495-1802 |
Authorized person
| Name | JOHN BOSWELL |
| Role | OWNER/PHYSICIAN |
| Phone | 2054951802 |
Taxonomy
| Taxonomy Code | 207QS1201X - Sleep Medicine (Family Medicine) Physician |
| License Number | MD25562 |
| State | AL |
| Is Primary | No |
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | MD25562 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 115649 |
| State | AL |
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 51597448 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| BOSWELL, JOHN | Agent | 621 COUNTY HIGHWAY 135GUIN, AL 35563 |
| Name | Role | Address |
|---|---|---|
| BOSWELL, JOHN | Incorporator | 621 COUNTY HIGHWAY 135GUIN, AL 35563 |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
