MEDICARE: BRANDON 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1366115784
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDON SCOTT

Provider Business Mailing Address
First Line	:	653 VICTORY RD
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45504-3737
Country	:	US
Telephone Number	:	937-521-0422
Fax Number	:

Provider Business Practice Location Address
First Line	:	653 VICTORY RD
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45504-3737
Country	:	US
Telephone Number	:	937-521-0422
Fax Number	:

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

Provider Enumeration Date	:	07/30/2021
Last Update Date	:	07/30/2021

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Directions to “ BRANDON SCOTT ” Practice Location

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