Organization
INDEPENDENT MEDICINE PROF LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANNETTE M BOSWORTH MD (PRESIDENT/CEO)
(605) 371-6899
Entity
Organization
Contact information
Practice address
204 E LAKE DR, ESTELLINE, SD 57234-6615
(605) 873-2133
(605) 873-2133
Mailing address
204 E LAKE DR, ESTELLINE, SD 57234-6615
(605) 873-2133
(605) 873-2133
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
6055
SD
Other
Enumeration date
10/15/2010
Last updated
06/21/2011
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