Healthcare Provider Details

I. General information

NPI: 1225725393
Provider Name (Legal Business Name): SCOTT B DEMASTERS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2023
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 LIVE STRONGER ST
TEA SD
57064-8331
US

IV. Provider business mailing address

2120 LIVE STRONGER ST
TEA SD
57064-8331
US

V. Phone/Fax

Practice location:
  • Phone: 605-982-9545
  • Fax: 605-982-9545
Mailing address:
  • Phone: 605-982-9545
  • Fax: 605-982-9545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: