1437195583 NPI number — DR. MISCHCA TAPSCOTT SCALES PH.D

Table of content: DR. MISCHCA TAPSCOTT SCALES PH.D (NPI 1437195583)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437195583 NPI number — DR. MISCHCA TAPSCOTT SCALES PH.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCALES
Provider First Name:
MISCHCA
Provider Middle Name:
TAPSCOTT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TAPSCOTT
Provider Other First Name:
MISCHCA
Provider Other Middle Name:
JANAYE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1437195583
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7417 TURNBUOY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78730-4333
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-507-6342
Provider Business Mailing Address Fax Number:
512-531-9271

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
441 HIGHWAY 71 W
Provider Second Line Business Practice Location Address:
A
Provider Business Practice Location Address City Name:
BASTROP
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78602-3931
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-507-6342
Provider Business Practice Location Address Fax Number:
512-531-9271
Provider Enumeration Date:
06/20/2006

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: 103TC0700X , with the licence number:  3-1559 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 600663363 . This is a "BLUE CROSS BLUE SHIELD TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 161254101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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