Healthcare Provider Details

I. General information

NPI: 1518277672
Provider Name (Legal Business Name): SCOTT D. FISCUS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2010
Last Update Date: 04/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2611 WESTWOOD DR SUITE A
NASHVILLE TN
37204-2709
US

IV. Provider business mailing address

2611 WESTWOOD DR SUITE A
NASHVILLE TN
37204-2709
US

V. Phone/Fax

Practice location:
  • Phone: 615-361-0930
  • Fax: 615-467-7507
Mailing address:
  • Phone: 615-361-0930
  • Fax: 615-467-7507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number02-294-20
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code156FX1700X
TaxonomyOcularist
License Number
License Number State

VIII. Authorized Official

Name: MR. SCOTT D FISCUS
Title or Position: OWNER
Credential: B.C.O.
Phone: 615-361-0930