Provider Demographics
NPI:1336749894
Name:SCOTT, ROBERT
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:SCOTT
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 1:27 MIDWAY LOOP
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-1373
Mailing Address - Country:US
Mailing Address - Phone:304-636-5252
Mailing Address - Fax:304-591-4521
Practice Address - Street 1:4122 BARBOUR COUNTY HWY
Practice Address - Street 2:
Practice Address - City:BELINGTON
Practice Address - State:WV
Practice Address - Zip Code:26250-8208
Practice Address - Country:US
Practice Address - Phone:304-614-3547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant