Jennifer Thomas Bolton, M.D.
Individual provider Active NPI Obstetrics & Gynecology Physician · Tuscalousa, AL
NPI 1538240809 · NPPES record last updated Jun 10, 2015
Key facts
- NPI
- 1538240809
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Obstetrics & Gynecology Physician 207V00000X
- License
- 19005 (AL)
- Practice address
- 100 Towncenter Blvd
Ste 201
Tuscalousa, AL 35406 - Phone
- (205) 366-9996
- Fax
- (205) 366-9971
- NPI assigned
- Oct 17, 2006
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20101115000019 | AL | Practitioner - Obstetrics/Gynecology | 2062607286 | Practice locations: Tuscaloosa, AL |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19005 | AL | MD | Obstetrics & Gynecology Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | 19005 | AL | Yes |
Addresses
Primary practice location
100 Towncenter Blvd
Ste 201
Tuscalousa, AL 35406
Mailing address
100 Towncenter Blvd
Suite 201
Tuscalousa, AL 35406
Phone (205) 366-9996
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000019004 | Medicaid | AL | |
| 34837 | Other | BLUE CROSS | |
| 000019005 | Medicaid | AL |
Other providers in Tuscalousa, AL
All providers in Tuscalousa, AL · Obstetrics & Gynecology Physician in Alabama
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 10, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.