Provider Demographics
NPI:1487602769
Name:GILLETTE, SCOTT D (CRNA)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:D
Last Name:GILLETTE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2090
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44309-2090
Mailing Address - Country:US
Mailing Address - Phone:330-375-3765
Mailing Address - Fax:330-375-7586
Practice Address - Street 1:525 E MARKET ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1619
Practice Address - Country:US
Practice Address - Phone:330-375-3765
Practice Address - Fax:330-375-7586
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC157695367500000X
OHRN-256368367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2080224OtherUNITED HEALTHCARE GROUP #
OH2541084Medicaid
OH100153OtherEMPLOYER KAISER GROUP #
OH34-0891295OtherEMPLOYER FEDERAL TAX ID #
OH000000357686OtherANTHEM BCBS INDV NUMBER
OH7091249Medicaid
OH730554OtherBUCKEYE COMMUNITY HLTH PL
OH2080224OtherUNITED HEALTHCARE GROUP #
OH100153OtherEMPLOYER KAISER GROUP #
OHGI8234871Medicare ID - Type UnspecifiedMEDICARE INDV NUMBER