Healthcare Provider Details

I. General information

NPI: 1023293750
Provider Name (Legal Business Name): SCOTT R BARTL PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2007
Last Update Date: 06/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11201 SHAKER BLVD SUITE 240
CLEVELAND OH
44104-3869
US

IV. Provider business mailing address

11201 SHAKER BLVD SUITE 240
CLEVELAND OH
44104-3869
US

V. Phone/Fax

Practice location:
  • Phone: 216-791-0017
  • Fax: 216-791-0021
Mailing address:
  • Phone: 216-791-0017
  • Fax: 216-791-0021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50002654
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: