Healthcare Provider Details

I. General information

NPI: 1952639890
Provider Name (Legal Business Name): SCOTT PHYSICIAN GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2009
Last Update Date: 12/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1451 N GARDNER ST
SCOTTSBURG IN
47170-7751
US

IV. Provider business mailing address

1451 N GARDNER ST
SCOTTSBURG IN
47170-7751
US

V. Phone/Fax

Practice location:
  • Phone: 812-752-8500
  • Fax:
Mailing address:
  • Phone: 812-752-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: CLIFFORD D. NAY
Title or Position: PRESIDENT
Credential:
Phone: 812-752-8500