1285603043 NPI number — SCOTT A BRANDT MD

Table of content: SCOTT A BRANDT MD (NPI 1285603043)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285603043 NPI number — SCOTT A BRANDT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRANDT
Provider First Name:
SCOTT
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
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:
1285603043
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
280 MAIN ST
Provider Second Line Business Mailing Address:
UNIT C-104
Provider Business Mailing Address City Name:
EDWARDS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81632
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-766-8245
Provider Business Mailing Address Fax Number:
970-432-7065

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
280 MAIN ST
Provider Second Line Business Practice Location Address:
UNIT C-104
Provider Business Practice Location Address City Name:
EDWARDS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-766-8245
Provider Business Practice Location Address Fax Number:
970-432-7065
Provider Enumeration Date:
03/15/2006

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: 207L00000X , with the licence number:  36941 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0014X , with the licence number: 36941 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 604688 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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