MEDICARE: SCOTT PENNINGTON M.D.

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	207L00000X	Anesthesiology Physician	01042814	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000000754101	OTHER	IN	ANTHEM

General Provider Information

NPI Number	:	1972501450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT PENNINGTON M.D.

Provider Business Mailing Address
First Line	:	1100 REID PARKWAY
Second Line	:	MEDICAL STAFF SERVICES
City	:	RICHMOND
State	:	IN
Zip	:	47374-1157
Country	:	US
Telephone Number	:	765-983-3127
Fax Number	:	765-983-3219

Provider Business Practice Location Address
First Line	:	1100 REID PARKWAY
Second Line	:	ANESTHESIA/SURGERY DEPARTMENT
City	:	RICHMOND
State	:	IN
Zip	:	47374-1157
Country	:	US
Telephone Number	:	765-935-8807
Fax Number	:	765-983-3219

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

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	11/15/2013

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Directions to “ SCOTT PENNINGTON M.D.” Practice Location

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