1063524494 NPI number — MS. WENDY STONE SCOTT PCC

Table of content: MS. WENDY STONE SCOTT PCC (NPI 1063524494)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063524494 NPI number — MS. WENDY STONE SCOTT PCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STONE SCOTT
Provider First Name:
WENDY
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STONE
Provider Other First Name:
WENDY
Provider Other Middle Name:
M.
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1063524494
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1437 LARCHMONT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44107-3401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-227-9647
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1005 ABBE RD N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELYRIA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44035-1613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
180-099-5522
Provider Business Practice Location Address Fax Number:
440-365-6519
Provider Enumeration Date:
08/31/2006

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: 101YM0800X , with the licence number:  E-0007643 , 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: 0308483 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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