Provider Demographics
NPI:1154389856
Name:NAGELY, SCOTT W (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:W
Last Name:NAGELY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 78009
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63178-8009
Mailing Address - Country:US
Mailing Address - Phone:866-898-7142
Mailing Address - Fax:616-975-9824
Practice Address - Street 1:1252 COUNTY RD 8
Practice Address - Street 2:
Practice Address - City:KEYSTONE
Practice Address - State:CO
Practice Address - Zip Code:80435-0000
Practice Address - Country:US
Practice Address - Phone:970-468-6677
Practice Address - Fax:970-468-7908
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008012510207P00000X
TXL4589207PE0004X
CODR.0041662207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX153533803Medicaid
TXH66709Medicare UPIN
TX153533803Medicaid