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General NPI Number Information
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NPI Number | 1659544989
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Entity Type | Organization
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Legal Business Name | TIMOTHY A. SCROGGINS, MD, INC.
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Dates
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Enumeration Date | 04/08/2008
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Last Update Date | 04/08/2008
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Provider Practice Location Address
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Address Line | 110 S JACKSON ST SUITE 8
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City | SPENCER
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State | OH
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Zip | 44275-9569
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Country | US
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Telephone | 330-648-9060
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Fax | 330-667-1011
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Provider Business Mailing Address
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Address Line | 5666 RICHMAN RD
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City | SPENCER
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State | OH
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Zip | 44275-9788
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Country | US
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Telephone | 330-648-9060
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Fax | 330-667-1011
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Authorized Official
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Title or Position | MEDICAL ASSISTANT
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Name | MRS. CHARLYN SUE SCROGGINS
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Credential |
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Telephone | 330-648-9060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | OH35079345S
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License Number State | OH
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