MEDICARE: MR. JAMES SCOTT III

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175T00000X	Peer Specialist		OH

General Provider Information

NPI Number	:	1205587128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES SCOTT III

Provider Business Mailing Address
First Line	:	19936 VAN AKEN BLVD APT 101
Second Line	:
City	:	SHAKER HTS
State	:	OH
Zip	:	44122-3604
Country	:	US
Telephone Number	:	216-470-8022
Fax Number	:

Provider Business Practice Location Address
First Line	:	19936 VAN AKEN BLVD APT 101
Second Line	:
City	:	SHAKER HTS
State	:	OH
Zip	:	44122-3604
Country	:	US
Telephone Number	:	216-470-8022
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2022
Last Update Date	:	05/25/2023

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Directions to “ MR. JAMES SCOTT III ” Practice Location

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