Michael  W  Bosserman    MD
Contract Details
Crestwood Family Care--Madison Boulevard
Facility name
Provider ID
P000007290
NPI
1659488385
Tax ID
273920921
Effective Date
5/18/2016
Last Updated
5/25/2016
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
96.00
Location Details
Address
8121 Madison Boulevard Suite 101-A
Madison, AL 35758
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