Basic Information
| Provider Information | |||||||||
| NPI: | 1497712376 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCOTT | ||||||||
| FirstName: | KIM | ||||||||
| MiddleName: | ELLEN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 876 | ||||||||
| Address2: | |||||||||
| City: | PRICE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 845010876 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4356139500 | ||||||||
| FaxNumber: | 4356139414 | ||||||||
| Practice Location | |||||||||
| Address1: | 1777 SUN PEAK DR | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | PARK CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840986725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4356450800 | ||||||||
| FaxNumber: | 4356473003 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2006 | ||||||||
| LastUpdateDate: | 06/26/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 322406-1205 | UT | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.