1285694299 NPI number — DIANE M SCOTT P.A.

Table of content: DIANE M SCOTT P.A. (NPI 1285694299)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285694299 NPI number — DIANE M SCOTT P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCOTT
Provider First Name:
DIANE
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.A.
Provider Gender Code:
F

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:
1285694299
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/31/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 859
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PAYSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85547-0859
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-472-5260
Provider Business Mailing Address Fax Number:
928-472-3444

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
126 E MAIN ST
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
PAYSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85541-5488
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-472-5260
Provider Business Practice Location Address Fax Number:
928-472-3444
Provider Enumeration Date:
03/24/2006

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: 363A00000X , with the licence number:  2192 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 714487 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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