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NPI Code Detail

MEDICARE: MR. SCOTT J DAVIS NP-C

MEDICARE:  MR. SCOTT J DAVIS  NP-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
1363LF0000XFamily Nurse Practitioner209.008413IL
2363L00000XNurse Practitioner209008413IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1IL6309OTHERILMEDICARE GROUP
2F400101031OTHERILMEDICARE INDIVIDUAL

General Provider Information

NPI Number : 1518269539
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. SCOTT J DAVIS NP-C
Provider Business Mailing Address
First Line : 1310 N MAIN ST STE 200
Second Line :
City : SANDWICH
State : IL
Zip : 60548-1397
Country : US
Telephone Number : 815-786-7150
Fax Number : 815-786-3785
Provider Business Practice Location Address
First Line : 1310 N MAIN ST STE 200
Second Line :
City : SANDWICH
State : IL
Zip : 60548-1397
Country : US
Telephone Number : 815-786-7150
Fax Number : 815-786-3785
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/23/2010
Last Update Date : 03/25/2020

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Directions to “ MR. SCOTT J DAVIS NP-C” Practice Location

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