1740235191 NPI number — SCOTT WILBER MD

Table of content: SCOTT WILBER MD (NPI 1740235191)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740235191 NPI number — SCOTT WILBER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILBER
Provider First Name:
SCOTT
Provider Middle Name:
Provider Name Prefix Text:
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:
1740235191
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/20/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4749
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEDFORD
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97501-0227
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-789-4111
Provider Business Mailing Address Fax Number:
541-789-5518

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
280 MAPLE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEDFORD
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97520-1552
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-201-4000
Provider Business Practice Location Address Fax Number:
330-375-3769
Provider Enumeration Date:
05/24/2006

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: 207P00000X , with the licence number:  35067329 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 990002104 . This is a "RR MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0199539 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 341779226W . This is a "SUMMACARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000138493 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 341779226003 . This is a "MED MUT OF OH/ 2 OF 3" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 61641 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 341779226002 . This is a "MED MUT OF OH/ 1 OF 3" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 341779226006 . This is a "MED MUT OF OH/ 3 OF 3" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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