Basic Information
| Provider Information | |||||||||
| NPI: | 1396758488 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCOTT | ||||||||
| FirstName: | PHYLLIS | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22 WALNUT ST | ||||||||
| Address2: | LAUREL HEALTH CENTER ADMINISTRATION | ||||||||
| City: | WELLSBORO | ||||||||
| State: | PA | ||||||||
| PostalCode: | 169011526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5707230500 | ||||||||
| FaxNumber: | 5707241197 | ||||||||
| Practice Location | |||||||||
| Address1: | 32 E LAWRENCE RD | ||||||||
| Address2: | LAWRENCEVILLE LAUREL HEALTH CENTER | ||||||||
| City: | LAWRENCEVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 169298801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5708270125 | ||||||||
| FaxNumber: | 5708270129 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2006 | ||||||||
| LastUpdateDate: | 09/01/2015 | ||||||||
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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 | 207Q00000X | MD042692L | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 101859312 | 05 | PA | MEDICAID |