Michael  W  Bosserman    MD
Contract Details
Crestwood Family Practice--Whitesport Drive
Facility name
Provider ID
P000007290
NPI
1659488385
Tax ID
273920921
Effective Date
5/18/2016
Last Updated
5/24/2016
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
96.00
Location Details
Address
333 Whitesport Drive Southwest Suite 200
Huntsville, AL 35801
United States
County
Madison
Phone
2564295248 (Phone)
Billing Details
Address
P.O. Box 689022
Franklin, TN 37068
Billing Phone
6154657000
Specialty Type
Occupational Medicine
Map
Address