Provider Demographics
NPI:1891929352
Name:BOSWELL ORTHOPAEDIC CLINIC
Entity type:Organization
Organization Name:BOSWELL ORTHOPAEDIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSWELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:214-348-8300
Mailing Address - Street 1:7249 WABASH CIR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-3535
Mailing Address - Country:US
Mailing Address - Phone:214-348-8300
Mailing Address - Fax:214-348-8720
Practice Address - Street 1:10611 GARLAND RD
Practice Address - Street 2:SUITE 209
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-2666
Practice Address - Country:US
Practice Address - Phone:214-348-8300
Practice Address - Fax:214-348-8720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC1812207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0464539Medicaid
TX0464539Medicaid
TX000699Medicare PIN