1477506186 NPI number — DR. SCOTT R OOSTERVEEN MD

Table of content: DR. SCOTT R OOSTERVEEN MD (NPI 1477506186)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477506186 NPI number — DR. SCOTT R OOSTERVEEN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OOSTERVEEN
Provider First Name:
SCOTT
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
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:
1477506186
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/26/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
60 COMMERCIAL ST STE 404
Provider Second Line Business Mailing Address:
CONCORD HOSPITAL MEDICAL OFFICE AT HORSESHOE POND
Provider Business Mailing Address City Name:
CONCORD
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03301-5096
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-228-1763
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
60 COMMERCIAL ST STE 404
Provider Second Line Business Practice Location Address:
CONCORD HOSPITAL MEDICAL OFFICE AT HORSESHOE POND
Provider Business Practice Location Address City Name:
CONCORD
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03301-5096
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-228-1763
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/17/2006

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: 207RG0100X , with the licence number:  MD431420 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0100X , with the licence number: 16487 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 410413700 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00444706 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1567068 . This is a "GATEWAY-WMG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30089000 . This is a "AMERIHEALTH MERCY-WMG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 416564 . This is a "UPMC-WMG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1963228 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 50069579 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 102054344 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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