Healthcare Provider Details

I. General information

NPI: 1669404976
Provider Name (Legal Business Name): MIKE SCOTT YOUNG CP,LP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 06/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6901 S PADRE ISLAND DR 103B
CORPUS CHRISTI TX
78412-4929
US

IV. Provider business mailing address

6901 S PADRE ISLAND DR 103B
CORPUS CHRISTI TX
78412-4929
US

V. Phone/Fax

Practice location:
  • Phone: 361-992-7016
  • Fax: 361-992-7369
Mailing address:
  • Phone: 361-992-7016
  • Fax: 361-992-7369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number224
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: