1043544505 NPI number — JAMES T SCOTT MD A PROFESSIONAL CORPORATION

Table of content: (NPI 1043544505)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043544505 NPI number — JAMES T SCOTT MD A PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAMES T SCOTT MD A PROFESSIONAL CORPORATION
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:
1043544505
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/10/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12011 SAN VICENTE BLVD
Provider Second Line Business Mailing Address:
408
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90049-4926
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-883-8153
Provider Business Mailing Address Fax Number:
310-454-7351

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12011 SAN VICENTE BLVD
Provider Second Line Business Practice Location Address:
408
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90049-4926
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-883-8153
Provider Business Practice Location Address Fax Number:
310-454-7351
Provider Enumeration Date:
09/30/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SCOTT
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
THOMAS
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
310-883-8153

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  G21732 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00G217320 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: DE555A . This is a "MEDICARE GROUP PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1770667578 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: DE556Z . This is a "MEDICARE INDIVIDUAL PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com