Provider Demographics
NPI:1306139191
Name:SCOTT A OWENS PC
Entity type:Organization
Organization Name:SCOTT A OWENS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:J
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:405-620-4191
Mailing Address - Street 1:PO BOX 7031
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73153-1031
Mailing Address - Country:US
Mailing Address - Phone:405-620-4191
Mailing Address - Fax:405-392-4191
Practice Address - Street 1:101 SE 4TH ST
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-5301
Practice Address - Country:US
Practice Address - Phone:405-793-8777
Practice Address - Fax:405-392-4191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-26
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2528111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1427163104OtherINDIVIDUAL NPI
1306139191OtherGROUP/BILLING NPI
OK1306139191OtherBLUE CROSS BLUE SHIELD
1427163104OtherINDIVIDUAL NPI