1568442655 NPI number — DR. SCOTT R SOVAR DC

Table of content: DR. SCOTT R SOVAR DC (NPI 1568442655)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568442655 NPI number — DR. SCOTT R SOVAR DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOVAR
Provider First Name:
SCOTT
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
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:
1568442655
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2816 VEACH RD
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
OWENSBORO
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42303-6295
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-684-4101
Provider Business Mailing Address Fax Number:
812-649-4927

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
826 N STATE ROAD 161 STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKPORT
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47635-9249
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-649-4926
Provider Business Practice Location Address Fax Number:
812-649-4927
Provider Enumeration Date:
01/17/2006

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: 111N00000X , with the licence number:  006209 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: 250353 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: 08002032A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111N00000X , with the licence number: 4286 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 200391820A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 85002871 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".