Basic Information
| Provider Information | |||||||||
| NPI: | 1689619439 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIMPSON | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | M. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7905 CALUMET AVE | ||||||||
| Address2: | HAMMOND CLINIC LLC | ||||||||
| City: | MUNSTER | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463211215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2198367214 | ||||||||
| FaxNumber: | 2198364829 | ||||||||
| Practice Location | |||||||||
| Address1: | 7905 CALUMET AVE | ||||||||
| Address2: | HAMMOND CLINIC LLC | ||||||||
| City: | MUNSTER | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463211215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2198367214 | ||||||||
| FaxNumber: | 2198364829 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2006 | ||||||||
| LastUpdateDate: | 12/28/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 01061084A | IN | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 200525460 | 05 | IN | MEDICAID |