=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689632846
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JEFFREY A SCOTT MD LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2006
-----------------------------------------------------
Last Update Date | 08/26/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13010 WHITE AVE SUITE A
-----------------------------------------------------
City | GRANDVIEW
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64030-2667
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-765-3888
-----------------------------------------------------
Fax | 816-763-8306
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13010 WHITE AVE SUITE A
-----------------------------------------------------
City | GRANDVIEW
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64030-2667
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-765-3888
-----------------------------------------------------
Fax | 816-763-8306
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MRS. MANETTE MARIE PALMER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 816-765-3888
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 36345
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------