1932274412 NPI number — SHIRLEY B SCOTT MD PC

Table of content: (NPI 1932274412)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932274412 NPI number — SHIRLEY B SCOTT MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHIRLEY B SCOTT MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932274412
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2670
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA FE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87504
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-986-9960
Provider Business Mailing Address Fax Number:
505-988-1550

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
428 LUISA PLACE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA FE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-986-9960
Provider Business Practice Location Address Fax Number:
505-988-1550
Provider Enumeration Date:
11/21/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SCOTT
Authorized Official First Name:
SHIRLEY
Authorized Official Middle Name:
B
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
505-986-9960

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X , with the licence number:  NM8995 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RI0200X , with the licence number: A034359 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)