1063444966 NPI number — COLLEEN M SCOTT D.O.

Table of content: COLLEEN M SCOTT D.O. (NPI 1063444966)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063444966 NPI number — COLLEEN M SCOTT D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCOTT
Provider First Name:
COLLEEN
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

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:
1063444966
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/17/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22905 W MAIN ST
Provider Second Line Business Mailing Address:
P.O.BOX 536
Provider Business Mailing Address City Name:
ARMADA
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48005-3247
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-864-7380
Provider Business Mailing Address Fax Number:
586-473-8129

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22905 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARMADA
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48005-3247
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-473-8082
Provider Business Practice Location Address Fax Number:
586-473-8129
Provider Enumeration Date:
07/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  5101014932 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 08-5501196-4 . This is a "BCBS PIN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4865992 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2515930 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4961907 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 700E012740 . This is a "BCBSM GROUP NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 700E031600 . This is a "BCBS GROUP NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 7852659 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com