Healthcare Provider Details

I. General information

NPI: 1851844559
Provider Name (Legal Business Name): SCOTT NO 1 INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2016
Last Update Date: 01/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28601 US HIGHWAY 61
SCOTT CITY MO
63780-9143
US

IV. Provider business mailing address

731 N MAIN ST
SIKESTON MO
63801-2151
US

V. Phone/Fax

Practice location:
  • Phone: 573-264-1555
  • Fax:
Mailing address:
  • Phone: 573-471-1276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number044502
License Number StateMO

VIII. Authorized Official

Name: DONALD B BEDELL
Title or Position: PRESIDENT
Credential:
Phone: 573-471-1276