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NPI Code Detail

MEDICARE: SOUTHBRIDGE MEDICAL ADVISORY COUNCIL, INC.

MEDICARE: SOUTHBRIDGE MEDICAL ADVISORY COUNCIL, INC.
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
1207Q00000XFamily Medicine Physician
2261QF0400XFederally Qualified Health Center (FQHC)

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1440009OTHERDEMEDICARE PROVIDER TRANSACTION ACCESS NUMBER

General Provider Information

NPI Number : 1760874549
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTHBRIDGE MEDICAL ADVISORY COUNCIL, INC.
Provider Business Mailing Address
First Line : 2722 PHILADELPHIA PIKE
Second Line :
City : CLAYMONT
State : DE
Zip : 19703-2568
Country : US
Telephone Number : 26-556-1873
Fax Number : 27-982-4733
Provider Business Practice Location Address
First Line : 2722 PHILADELPHIA PIKE
Second Line :
City : CLAYMONT
State : DE
Zip : 19703-2568
Country : US
Telephone Number : 302-655-6187
Fax Number : 302-798-2473
Authorized Official
Title or Position : CEO
Name : MS. NACHET SCOTT
Credential :
Telephone Number : 26-593-0773
Provider Enumeration Date : 03/03/2015
Last Update Date : 05/21/2019

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Directions to “SOUTHBRIDGE MEDICAL ADVISORY COUNCIL, INC. ” Practice Location

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