MEDICARE: DUSTIN SCOTT BSW

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1598170284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DUSTIN SCOTT BSW

Provider Business Mailing Address
First Line	:	1324 OGDEN ST APT 1
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80218-1964
Country	:	US
Telephone Number	:	206-779-0423
Fax Number	:

Provider Business Practice Location Address
First Line	:	1324 OGDEN ST APT 1
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80218-1964
Country	:	US
Telephone Number	:	206-779-0423
Fax Number	:

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

Provider Enumeration Date	:	06/22/2014
Last Update Date	:	06/22/2014

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