Healthcare Provider Details

I. General information

NPI: 1235782814
Provider Name (Legal Business Name): SCOTT EDWARD FOOR M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2019
Last Update Date: 07/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2353 N 9TH ST LOT A111
LARAMIE WY
82072-1609
US

IV. Provider business mailing address

2353 N 9TH ST LOT A111
LARAMIE WY
82072-1609
US

V. Phone/Fax

Practice location:
  • Phone: 805-704-0721
  • Fax:
Mailing address:
  • Phone: 805-704-0721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number69611
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number69611
License Number StateWY
# 3
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number69611
License Number StateWY
# 4
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number69611
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: