Provider Demographics
NPI:1063237121
Name:SCOTT II MEDICAL CLINIC
Entity type:Organization
Organization Name:SCOTT II MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ANESTHESIOLOGIST/ATTORNEY/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GENE
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:II
Authorized Official - Credentials:MD, DO
Authorized Official - Phone:480-208-6728
Mailing Address - Street 1:4839 SOUTH DARROW DRIVE
Mailing Address - Street 2:G258
Mailing Address - City:TAMPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-6661
Mailing Address - Country:US
Mailing Address - Phone:480-203-6728
Mailing Address - Fax:
Practice Address - Street 1:4839 SOUTH DARROW DRIVE
Practice Address - Street 2:G258
Practice Address - City:TAMPA
Practice Address - State:AZ
Practice Address - Zip Code:85282-6661
Practice Address - Country:US
Practice Address - Phone:480-203-6728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SCOTT II MEDICAL CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-11-22
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty