MEDICARE: SCOOTER DIGGES AND ASSOCIATES, PC

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	174400000X	Specialist	24718	OK

General Provider Information

NPI Number	:	1932123510
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCOOTER DIGGES AND ASSOCIATES, PC

Provider Business Mailing Address
First Line	:	4140 W MEMORIAL RD
Second Line	:	SUITE 116
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-8366
Country	:	US
Telephone Number	:	405-607-8222
Fax Number	:	866-322-0876

Provider Business Practice Location Address
First Line	:	4140 W MEMORIAL AVE
Second Line	:	SUITE 116
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-8300
Country	:	US
Telephone Number	:	405-607-8222
Fax Number	:	866-322-0876

Authorized Official
Title or Position	:	OWNER PHYSICIAN
Name	:	DR. EDWARD NICHOLAS DIGGES
Credential	:	M.D.
Telephone Number	:	405-607-8222

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	04/10/2014

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