MEDICARE: SCOTT ISGRIGG

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	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1710749742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT ISGRIGG

Provider Business Mailing Address
First Line	:	80 HIGHWAY 2227
Second Line	:
City	:	SOMERSET
State	:	KY
Zip	:	42503-1562
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8963 KINGSRIDGE DR STE A
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45458-1623
Country	:	US
Telephone Number	:	513-464-9220
Fax Number	:

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

Provider Enumeration Date	:	01/25/2024
Last Update Date	:	01/25/2024

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Directions to “ SCOTT ISGRIGG ” Practice Location

Language	Start Address	Practice Location

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