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NPI Code Detail

MEDICARE: OLIVER MARC SCROGGINS MHPP

MEDICARE:   OLIVER MARC SCROGGINS  MHPP
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1922120765
Entity Type Code : Individual
Provider Name (Legal Business Name) : OLIVER MARC SCROGGINS MHPP
Provider Business Mailing Address
First Line : 3352 N FUTRALL DR
Second Line :
City : FAYETTEVILLE
State : AR
Zip : 72703-4057
Country : US
Telephone Number : 479-521-5868
Fax Number :
Provider Business Practice Location Address
First Line : 1484 W 1ST ST N
Second Line :
City : PRESCOTT
State : AR
Zip : 71857-3339
Country : US
Telephone Number : 870-887-1078
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/04/2007
Last Update Date : 08/29/2011

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Directions to “ OLIVER MARC SCROGGINS MHPP” Practice Location

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