1528224185 NPI number — SCOTT ORTHOPAEDIC AND SPINE CENTER LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528224185 NPI number — SCOTT ORTHOPAEDIC AND SPINE CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SCOTT ORTHOPAEDIC AND SPINE CENTER LLC
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:
1528224185
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 HARRIS INDUSTRIAL BLVD
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
VIDALIA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30474-8852
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-537-4411
Provider Business Mailing Address Fax Number:
912-538-8485

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 HARRIS INDUSTRIAL BLVD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
VIDALIA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30474-8852
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-537-4411
Provider Business Practice Location Address Fax Number:
912-538-8485
Provider Enumeration Date:
08/04/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SCOTT
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
CULLEN
Authorized Official Title or Position:
PRINCIPLE
Authorized Official Telephone Number:
912-537-4411

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  057015 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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