Provider Demographics
NPI:1386977452
Name:HIATT, SCOTT A
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:A
Last Name:HIATT
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 1:1900 E. 10TH STREET
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-5053
Mailing Address - Country:US
Mailing Address - Phone:575-437-7404
Mailing Address - Fax:575-439-2861
Practice Address - Street 1:1900 E. 10TH STREET
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-5053
Practice Address - Country:US
Practice Address - Phone:575-437-7404
Practice Address - Fax:575-439-2861
Is Sole Proprietor?:No
Enumeration Date:2009-09-08
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator