Healthcare Provider Details

I. General information

NPI: 1396748992
Provider Name (Legal Business Name): SCOTT LORING ACKLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 02/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1606 N 7TH ST
TERRE HAUTE IN
47804-2706
US

IV. Provider business mailing address

6100 W 96TH ST SUITE 125
INDIANAPOLIS IN
46278-6005
US

V. Phone/Fax

Practice location:
  • Phone: 812-238-7504
  • Fax: 812-238-7151
Mailing address:
  • Phone: 317-715-1800
  • Fax: 317-715-6200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number01042399A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: