Basic Information
| Provider Information | |||||||||
| NPI: | 1235626318 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STRAIT | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | THOMAS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1775 W LEXINGTON STE 100 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452123667 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5139776701 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 ARROW SPRINGS BLVD STE 2700 | ||||||||
| Address2: | |||||||||
| City: | LEBANON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450367019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132827911 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2018 | ||||||||
| LastUpdateDate: | 08/31/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35.142796 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | TK864943 | OH | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0295793 | 05 | OH | MEDICAID |