Basic Information
| Provider Information | |||||||||
| NPI: | 1871779843 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SCOTT R. VOSLER, D.O. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 450B WASHINGTON JACKSON RD | ||||||||
| Address2: | SUTIE 104 | ||||||||
| City: | EATON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453207600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9374568340 | ||||||||
| FaxNumber: | 9374568341 | ||||||||
| Practice Location | |||||||||
| Address1: | 450B WASHINGTON JACKSON RD | ||||||||
| Address2: | SUTIE 104 | ||||||||
| City: | EATON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453207600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9374568340 | ||||||||
| FaxNumber: | 9374568341 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/21/2008 | ||||||||
| LastUpdateDate: | 01/21/2008 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | VOSLER | ||||||||
| AuthorizedOfficialFirstName: | SCOTT | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 9374568340 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | D.O. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 1071818 | OH | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | 1043717 | OH | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 207Q00000X | 3526 | OH | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0517711 | 05 | OH | MEDICAID |