Healthcare Provider Details

I. General information

NPI: 1720499429
Provider Name (Legal Business Name): SCOTT WEBER COTS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2014
Last Update Date: 05/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 N SILVER ST
TRUTH OR CONSEQUENCES NM
87901-1957
US

IV. Provider business mailing address

1400 N SILVER ST
TRUTH OR CONSEQUENCES NM
87901-1957
US

V. Phone/Fax

Practice location:
  • Phone: 575-894-1735
  • Fax:
Mailing address:
  • Phone: 575-894-1735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number2851
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: