1518989961 NPI number — NANCY KAY SCOTT ET AL PTR

Table of content: (NPI 1518989961)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518989961 NPI number — NANCY KAY SCOTT ET AL PTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NANCY KAY SCOTT ET AL PTR
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:
6
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:
1518989961
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 E 2ND STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILAN
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63556
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
660-265-3779
Provider Business Mailing Address Fax Number:
660-265-3966

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 E 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILAN
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63556-1331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-265-3779
Provider Business Practice Location Address Fax Number:
660-265-3966
Provider Enumeration Date:
07/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SCOTT
Authorized Official First Name:
NANCY
Authorized Official Middle Name:
K.
Authorized Official Title or Position:
OWNER/OPERATOR/PHARMACY TECHNICIAN
Authorized Official Telephone Number:
660-265-3779

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  2004008818 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 602151003 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2627593 . This is a "NCPDP" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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