Provider Demographics
NPI:1316904295
Name:RUSSELL, SCOTT C (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:C
Last Name:RUSSELL
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 1:4321 WASHINGTON ST
Mailing Address - Street 2:SUITE 3000
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-5961
Mailing Address - Country:US
Mailing Address - Phone:816-932-3100
Mailing Address - Fax:816-932-6863
Practice Address - Street 1:4321 WASHINGTON ST
Practice Address - Street 2:SUITE 3000
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-5961
Practice Address - Country:US
Practice Address - Phone:816-932-3100
Practice Address - Fax:816-932-6863
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007024413207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO206233900Medicaid
MO206233900Medicaid
H33548Medicare UPIN