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1811044167

NPI Code Detail

MEDICARE: SCOTT M BOUTON MD

MEDICARE: SCOTT M BOUTON MD

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	2080P0204X	Pediatric Emergency Medicine (Pediatrics) Physician	35-084734	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
9	P00412306	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000337118	OTHER	OH	ANTHEM
2	732324	OTHER	OH	BUCKEYE
3	000000221061	OTHER	OH	UNISON
4	363374	OTHER	OH	WELLCARE
5	7288591	OTHER	OH	AETNA
6	2502410	OTHER	OH	BCMH
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811044167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT M BOUTON MD

Provider Business Mailing Address
First Line	:	3605 WARRENSVILLE CENTER RD
Second Line	:
City	:	SHAKER HTS
State	:	OH
Zip	:	44122-5203
Country	:	US
Telephone Number	:	440-684-5829
Fax Number	:	440-449-1555

Provider Business Practice Location Address
First Line	:	11000 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-1714
Country	:	US
Telephone Number	:	440-684-5829
Fax Number	:	440-449-1555

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

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	05/20/2008

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Directions to “ SCOTT M BOUTON MD” Practice Location

Language	Start Address	Practice Location

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