Provider Demographics
NPI:1144574922
Name:BOYETT HEALTH SERVICES
Entity Type:Organization
Organization Name:BOYETT HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:EDGEWORTH
Authorized Official - Last Name:BOYETT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, DO
Authorized Official - Phone:205-921-0893
Mailing Address - Street 1:PO BOX 747
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:AL
Mailing Address - Zip Code:35570-0747
Mailing Address - Country:US
Mailing Address - Phone:205-921-0893
Mailing Address - Fax:205-921-6723
Practice Address - Street 1:2131 MILITARY ST S
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:AL
Practice Address - Zip Code:35570-6651
Practice Address - Country:US
Practice Address - Phone:205-921-0893
Practice Address - Fax:205-921-6723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-01
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4622122300000X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty