Provider Demographics
NPI:1154803047
Name:SCRUGGS, BOBBY D
Entity type:Individual
Prefix:
First Name:BOBBY
Middle Name:D
Last Name:SCRUGGS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4304 ADIRONDACK SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78738-4037
Mailing Address - Country:US
Mailing Address - Phone:651-343-0727
Mailing Address - Fax:
Practice Address - Street 1:4304 ADIRONDACK SUMMIT DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78738-4037
Practice Address - Country:US
Practice Address - Phone:651-343-0727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX803088282OtherSCRUGGS FAMILY ENTERPRISES