1548351232 NPI number — SCOTT H NEARING DDS

Table of content: SCOTT H NEARING DDS (NPI 1548351232)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548351232 NPI number — SCOTT H NEARING DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEARING
Provider First Name:
SCOTT
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDS
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:
1548351232
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3011 N MICHIGAN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSBURG
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66762-2546
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
620-231-9873
Provider Business Mailing Address Fax Number:
620-231-5062

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3011 N MICHIGAN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSBURG
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66762-2546
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-231-9873
Provider Business Practice Location Address Fax Number:
620-231-5062
Provider Enumeration Date:
09/27/2006

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: 1223G0001X , with the licence number:  60020 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100386960B , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 116989 . This is a "BCBS OF KS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".