Healthcare Provider Details

I. General information

NPI: 1285005405
Provider Name (Legal Business Name): SCOTT ORTHOPEDIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2015
Last Update Date: 10/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 1ST AVE SUITE 400
HUNTINGTON WV
25702-1236
US

IV. Provider business mailing address

2828 1ST AVE SUITE 400
HUNTINGTON WV
25702-1236
US

V. Phone/Fax

Practice location:
  • Phone: 304-525-6905
  • Fax: 304-525-6154
Mailing address:
  • Phone: 304-525-6905
  • Fax: 304-525-6154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: DAVID PROCTOR
Title or Position: ADMINISTRATOR
Credential:
Phone: 304-525-6905