1598722951 NPI number — SCOTT D ALLEN MD & ASSOCIATES PC

Table of content: (NPI 1598722951)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598722951 NPI number — SCOTT D ALLEN MD & ASSOCIATES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SCOTT D ALLEN MD & ASSOCIATES PC
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:
NEW MEXICO EYE CLINIC OF FARMINGTON
Provider Other Organization Name Type Code:
4
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:
1598722951
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2300 E 30TH ST
Provider Second Line Business Mailing Address:
STE 105
Provider Business Mailing Address City Name:
FARMINGTON
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87401-8990
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-327-0406
Provider Business Mailing Address Fax Number:
505-326-4691

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2300 E 30TH ST
Provider Second Line Business Practice Location Address:
STE 105
Provider Business Practice Location Address City Name:
FARMINGTON
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87401-8990
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-327-0406
Provider Business Practice Location Address Fax Number:
505-326-4691
Provider Enumeration Date:
04/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ALLEN
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OWNER/PHYSICIAN
Authorized Official Telephone Number:
505-325-5021

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  95-172 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 201000176 . This is a "PRESBYTERIAN HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: A2357 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: CJ4675 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




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