MEDICARE: SCOTT THOMAS WELCH PA-C

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	363A00000X	Physician Assistant	55257	CA

General Provider Information

NPI Number	:	1093221020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT THOMAS WELCH PA-C

Provider Business Mailing Address
First Line	:	6465 RAND ST
Second Line	:
City	:	MOORPARK
State	:	CA
Zip	:	93021-1419
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2750 PARK VIEW CT STE 250
Second Line	:
City	:	OXNARD
State	:	CA
Zip	:	93036-5458
Country	:	US
Telephone Number	:	805-278-1688
Fax Number	:	805-278-1699

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

Provider Enumeration Date	:	12/28/2017
Last Update Date	:	12/28/2017

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