1578754487 NPI number — SCOTT N BATEMAN, MD

Table of content: (NPI 1578754487)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578754487 NPI number — SCOTT N BATEMAN, MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SCOTT N BATEMAN, MD
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:
SHERIDAN EAR NOSE & THROAT
Provider Other Organization Name Type Code:
3
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:
1578754487
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
330 W DOW ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHERIDAN
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82801-3829
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-672-0290
Provider Business Mailing Address Fax Number:
307-672-0884

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
330 W DOW ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHERIDAN
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82801-3829
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-672-0290
Provider Business Practice Location Address Fax Number:
307-672-0884
Provider Enumeration Date:
08/06/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BATEMAN
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
N
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
307-672-0290

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , with the licence number:  5710A , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332S00000X , with the licence number: 5710A , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 01033001 . This is a "BLUE CROSS AND BLUE SHIELD" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".
  • Identifier: 112709801 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".