1295812964 NPI number — SCOTT M MORCOTT, MD SC

Table of content: (NPI 1295812964)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295812964 NPI number — SCOTT M MORCOTT, MD SC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SCOTT M MORCOTT, MD SC
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:
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:
1295812964
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
250 CENTER DR
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
VERNON HILLS
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60061-1582
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-816-8686
Provider Business Mailing Address Fax Number:
847-816-8898

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 CENTER DR
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
VERNON HILLS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60061-1582
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-816-8686
Provider Business Practice Location Address Fax Number:
847-816-8898
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MORCOTT
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER/MEDICAL DIRECTOR
Authorized Official Telephone Number:
847-816-8686

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  036099609 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1386638708 . This is a "NPI" identifier . This identifiers is of the category "OTHER".




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