Provider Demographics
NPI:1306075171
Name:SCOTT A. WENGER, M.D., PLLC
Entity type:Organization
Organization Name:SCOTT A. WENGER, M.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:WENGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-616-0700
Mailing Address - Street 1:8801 NORTH TARRANT PKWY
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76182-8461
Mailing Address - Country:US
Mailing Address - Phone:817-616-0700
Mailing Address - Fax:817-616-0708
Practice Address - Street 1:8801 NORTH TARRANT PKWY
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76182-8461
Practice Address - Country:US
Practice Address - Phone:817-616-0700
Practice Address - Fax:817-616-0708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-14
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A5383Medicare PIN