Basic Information
| Provider Information | |||||||||
| NPI: | 1306873245 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCOTT | ||||||||
| FirstName: | CAROL | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 805 | ||||||||
| Address2: | |||||||||
| City: | NEVADA CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95959 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5302711791 | ||||||||
| FaxNumber: | 5302712090 | ||||||||
| Practice Location | |||||||||
| Address1: | 880 ALDER AVE | ||||||||
| Address2: | |||||||||
| City: | INCLINE VILLAGE | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5305823200 | ||||||||
| FaxNumber: | 5305876126 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | G74575 | CA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00G745750 | 05 | CA | MEDICAID |