Healthcare Provider Details

I. General information

NPI: 1710801410
Provider Name (Legal Business Name): MR. SANDY MCINTOSH SCOTT II
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 S 8TH ST
NORFOLK NE
68701-5875
US

IV. Provider business mailing address

PO BOX 636
WINNEBAGO NE
68071-0636
US

V. Phone/Fax

Practice location:
  • Phone: 402-500-6870
  • Fax:
Mailing address:
  • Phone: 712-577-2611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: