1669465621 NPI number — WILLIAM M SCOVELL JR. MD

Table of content: WILLIAM M SCOVELL JR. MD (NPI 1669465621)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669465621 NPI number — WILLIAM M SCOVELL JR. MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCOVELL
Provider First Name:
WILLIAM
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
Provider Credential Text:
MD
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:
1669465621
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2121 HUGHES DR
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
TOLEDO
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43606-3845
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-291-2121
Provider Business Mailing Address Fax Number:
419-479-6017

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2121 HUGHES DR
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
TOLEDO
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43606-3845
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-291-2121
Provider Business Practice Location Address Fax Number:
419-479-6017
Provider Enumeration Date:
08/25/2005

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: 208000000X , with the licence number:  35079388 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 17008 . This is a "HPM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2246126 . This is a "BCMH" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 7775293 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 12-03688 . This is a "UHC" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 000000203188 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 12-03664 . This is a "UHC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 4061 . This is a "PHC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2246126 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000216366 . This is a "ANTHEM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 3505802321 . This is a "BCBS MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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