MEDICARE: SCOTT INTEGRATED PAIN MANAGEMENT LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207L00000X	Anesthesiology Physician
2	207R00000X	Internal Medicine Physician
3	207LP2900X	Pain Medicine (Anesthesiology) Physician

General Provider Information

NPI Number	:	1801368824
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCOTT INTEGRATED PAIN MANAGEMENT LLC

Provider Business Mailing Address
First Line	:	3300 HENRY AVE STE 112
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19129-1146
Country	:	US
Telephone Number	:	215-825-5989
Fax Number	:	866-893-6393

Provider Business Practice Location Address
First Line	:	3300 HENRY AVE STE 112
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19129-1146
Country	:	US
Telephone Number	:	215-825-5979
Fax Number	:	866-893-6393

Authorized Official
Title or Position	:	OWNER
Name	:	DR. THOMAS HYDE SCOTT
Credential	:	MD
Telephone Number	:	215-825-5979

Provider Enumeration Date	:	01/02/2019
Last Update Date	:	04/26/2024

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