Basic Information
| Provider Information | |||||||||
| NPI: | 1952639890 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SCOTT PHYSICIAN GROUP LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1451 N GARDNER ST | ||||||||
| Address2: | |||||||||
| City: | SCOTTSBURG | ||||||||
| State: | IN | ||||||||
| PostalCode: | 471707751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8127528500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1451 N GARDNER ST | ||||||||
| Address2: | |||||||||
| City: | SCOTTSBURG | ||||||||
| State: | IN | ||||||||
| PostalCode: | 471707751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8127528500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2009 | ||||||||
| LastUpdateDate: | 12/04/2009 | ||||||||
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| AuthorizedOfficialLastName: | NAY | ||||||||
| AuthorizedOfficialFirstName: | CLIFFORD | ||||||||
| AuthorizedOfficialMiddleName: | D. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8127528500 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SCOTT MEMORIAL HOSPITAL | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | 207RE0101X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | 207V00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207X00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.