MEDICARE: SCOTT COLLINS P.A.-C.

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant	PA-864	ME

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
7	P00239889	OTHER	ME	RR MEDICARE

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	010507276	OTHER	ME	TAX ID
2	1120990001	OTHER	ME	DMERC
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	7554653	OTHER	ME	AETNA NON-HMO
5	3690583	OTHER	ME	AETNA HMO
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	047836	OTHER	ME	ANTHEM

NPI Number	:	1700813979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT COLLINS P.A.-C.

Provider Business Mailing Address
First Line	:	20 NORTHBROOK DR
Second Line	:
City	:	FALMOUTH
State	:	ME
Zip	:	04105-1318
Country	:	US
Telephone Number	:	207-781-4424
Fax Number	:

Provider Business Practice Location Address
First Line	:	20 NORTHBROOK DR
Second Line	:
City	:	FALMOUTH
State	:	ME
Zip	:	04105-1318
Country	:	US
Telephone Number	:	207-781-4424
Fax Number	:

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

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	07/21/2015

22 NORTHBROOK DR
FALMOUTH, ME
04105-1318

Practice Phone: 323-928-9445
Practice Fax: