1497996771 NPI number — SCOTT WALKER BROWN BS

Table of content: SCOTT WALKER BROWN BS (NPI 1497996771)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497996771 NPI number — SCOTT WALKER BROWN BS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
SCOTT
Provider Middle Name:
WALKER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BS
Provider Gender Code:
M

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:
1497996771
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/16/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
N36755 SCHANSBERG RD
Provider Second Line Business Mailing Address:
LOT 1
Provider Business Mailing Address City Name:
WHITEHALL
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54773-9174
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-538-4686
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1407 SAINT ANDREW ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
LA CROSSE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54603-3301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-989-2741
Provider Business Practice Location Address Fax Number:
608-785-5331
Provider Enumeration Date:
03/16/2009

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: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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