1962427997 NPI number — STEVE SCOTT MD

Table of content: STEVE SCOTT MD (NPI 1962427997)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962427997 NPI number — STEVE SCOTT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCOTT
Provider First Name:
STEVE
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:
1962427997
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1515 N HARVARD AVE
Provider Second Line Business Mailing Address:
SUITE E
Provider Business Mailing Address City Name:
TULSA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74115-4957
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-832-6049
Provider Business Mailing Address Fax Number:
918-832-6055

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1919 S WHEELING AVE
Provider Second Line Business Practice Location Address:
SUITE 500
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74104-5638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-748-7650
Provider Business Practice Location Address Fax Number:
918-293-3147
Provider Enumeration Date:
07/12/2006

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: 207RC0000X , with the licence number:  19020 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100119650A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00295067 . This is a "RR MEDICARE" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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