MEDICARE: LAURA M SCOTT P.A.-C

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	363AS0400X	Surgical Physician Assistant	LG004143	MI

General Provider Information

NPI Number	:	1285675843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA M SCOTT P.A.-C

Provider Business Mailing Address
First Line	:	4007 ORCHARD DR
Second Line	:	SUITE 2003
City	:	MIDLAND
State	:	MI
Zip	:	48640-6187
Country	:	US
Telephone Number	:	989-631-6710
Fax Number	:	989-631-8583

Provider Business Practice Location Address
First Line	:	4007 ORCHARD DR
Second Line	:	SUTIE 2003
City	:	MIDLAND
State	:	MI
Zip	:	48640-6187
Country	:	US
Telephone Number	:	989-631-6710
Fax Number	:	989-631-8583

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

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	09/24/2009

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