1508806704 NPI number — DR. SCOTT A LOCKWOOD MD

Table of content: DR. SCOTT A LOCKWOOD MD (NPI 1508806704)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508806704 NPI number — DR. SCOTT A LOCKWOOD MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOCKWOOD
Provider First Name:
SCOTT
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1508806704
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/12/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2871 E OLD ORCHARD TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SIOUX FALLS
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57103-4369
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-334-2454
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1301 S CLIFF AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SIOUX FALLS
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57105-1005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-322-7246
Provider Business Practice Location Address Fax Number:
605-322-2891
Provider Enumeration Date:
06/07/2006

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: 207LP2900X , with the licence number:  3564 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2F818LO . This is a "BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 984625 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0002152 . This is a "BLUE SHIELD" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 532507200 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5700560 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".




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