MEDICARE: MRS. MARIA C. SCOTT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171W00000X	Contractor

General Provider Information

NPI Number	:	1023139565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARIA C. SCOTT

Provider Business Mailing Address
First Line	:	9429 SE 29TH ST
Second Line	:	LOT 114
City	:	MIDWEST CITY
State	:	OK
Zip	:	73130-7205
Country	:	US
Telephone Number	:	405-737-3299
Fax Number	:

Provider Business Practice Location Address
First Line	:	9429 SE 29TH ST
Second Line	:	LOT 114
City	:	MIDWEST CITY
State	:	OK
Zip	:	73130-7205
Country	:	US
Telephone Number	:	405-737-3299
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	07/09/2007

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