MEDICARE: SUSAN SCOTT CMP

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1639375181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN SCOTT CMP

Provider Business Mailing Address
First Line	:	PO BOX 1589
Second Line	:
City	:	BENTON
State	:	AR
Zip	:	72018-1589
Country	:	US
Telephone Number	:	501-315-3344
Fax Number	:

Provider Business Practice Location Address
First Line	:	417 N PEABODY AVE
Second Line	:
City	:	MOUNTAIN VIEW
State	:	AR
Zip	:	72560-6018
Country	:	US
Telephone Number	:	870-269-7577
Fax Number	:

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

Provider Enumeration Date	:	06/22/2007
Last Update Date	:	07/08/2007

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