Provider Demographics
NPI:1346329935
Name:BOSWELL REGIONAL CENTER
Entity Type:Organization
Organization Name:BOSWELL REGIONAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:601-867-5000
Mailing Address - Street 1:SIMPSON OLD HWY 49
Mailing Address - Street 2:
Mailing Address - City:MAGEE
Mailing Address - State:MS
Mailing Address - Zip Code:39111-0128
Mailing Address - Country:US
Mailing Address - Phone:601-867-5000
Mailing Address - Fax:601-867-5236
Practice Address - Street 1:SIMPSON OLD HWY 49 NORTH
Practice Address - Street 2:
Practice Address - City:MAGEE
Practice Address - State:MS
Practice Address - Zip Code:39111-0128
Practice Address - Country:US
Practice Address - Phone:601-867-5000
Practice Address - Fax:601-867-5236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSW0709411320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0115731Medicaid
MS0115731Medicaid