MEDICARE: KEM E SCOTT

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	172A00000X	Driver

General Provider Information

NPI Number	:	1891349445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEM E SCOTT

Provider Business Mailing Address
First Line	:	3031 SHELBY ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-3102
Country	:	US
Telephone Number	:	317-658-3276
Fax Number	:	317-820-3535

Provider Business Practice Location Address
First Line	:	3031 SHELBY ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-3102
Country	:	US
Telephone Number	:	317-658-3276
Fax Number	:	317-820-3535

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

Provider Enumeration Date	:	07/31/2019
Last Update Date	:	07/31/2019

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Directions to “ KEM E SCOTT ” Practice Location

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