Basic Information
| Provider Information | |||||||||
| NPI: | 1376096404 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BOYETT ORTHOSPINE INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1860 US HIGHWAY 43 | ||||||||
| Address2: | |||||||||
| City: | WINFIELD | ||||||||
| State: | AL | ||||||||
| PostalCode: | 355945062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2054871111 | ||||||||
| FaxNumber: | 2054871114 | ||||||||
| Practice Location | |||||||||
| Address1: | 15243 GREENFIELD DR | ||||||||
| Address2: | SUITE A | ||||||||
| City: | ATHENS | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356132899 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2562332332 | ||||||||
| FaxNumber: | 2562163579 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2016 | ||||||||
| LastUpdateDate: | 07/25/2016 | ||||||||
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| AuthorizedOfficialLastName: | BOYETT | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | BLAKE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2054871111 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Q4043 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.