MEDICARE: MR. SCOTT DILLON B.A.

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	:	1770949216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SCOTT DILLON B.A.

Provider Business Mailing Address
First Line	:	3896 SWENSON ST
Second Line	:	APARTMENT #1204-A
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-7408
Country	:	US
Telephone Number	:	732-904-9522
Fax Number	:	732-904-9522

Provider Business Practice Location Address
First Line	:	3896 SWENSON ST
Second Line	:	APARTMENT #1204-A
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-7408
Country	:	US
Telephone Number	:	732-904-9522
Fax Number	:	732-904-9522

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

Provider Enumeration Date	:	01/14/2016
Last Update Date	:	01/14/2016

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