Provider Demographics
NPI:1194136788
Name:SCOTT M WIGGINTON MD INC
Entity type:Organization
Organization Name:SCOTT M WIGGINTON MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES-BARTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-255-8825
Mailing Address - Street 1:500 UNIVERSITY AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-6514
Mailing Address - Country:US
Mailing Address - Phone:916-570-2850
Mailing Address - Fax:916-570-2854
Practice Address - Street 1:500 UNIVERSITY AVE STE 112
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-6514
Practice Address - Country:US
Practice Address - Phone:916-570-2850
Practice Address - Fax:916-570-2854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-16
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG46575207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty