Basic Information
| Provider Information | |||||||||
| NPI: | 1760787840 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SCOT E. HAGADORN M.D., PC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 41 | ||||||||
| Address2: | |||||||||
| City: | MUNCIE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 473080041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7652840493 | ||||||||
| FaxNumber: | 7652842434 | ||||||||
| Practice Location | |||||||||
| Address1: | 1660 LAFAYETTE RD | ||||||||
| Address2: | SUITE #100 | ||||||||
| City: | CRAWFORDSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 479334601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7653591660 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2011 | ||||||||
| LastUpdateDate: | 10/10/2011 | ||||||||
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| AuthorizedOfficialLastName: | HAGADORN | ||||||||
| AuthorizedOfficialFirstName: | SCOT | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 7652840493 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 201010520 | 05 | IN | MEDICAID |