Provider Demographics
NPI:1538135314
Name:SCATES, MICHAEL TRENT (PA-C, MS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:TRENT
Last Name:SCATES
Suffix:
Gender:M
Credentials:PA-C, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:TN
Mailing Address - Zip Code:38237-3309
Mailing Address - Country:US
Mailing Address - Phone:731-587-9511
Mailing Address - Fax:731-587-0785
Practice Address - Street 1:117 KENNEDY DR
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:TN
Practice Address - Zip Code:38237-3309
Practice Address - Country:US
Practice Address - Phone:731-587-9511
Practice Address - Fax:731-587-0785
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA791363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN40152366OtherBLUE CROSS BLUE SHIELD
970029695OtherRAILROAD MEDICARE
970029695OtherRAILROAD MEDICARE
TN40152366OtherBLUE CROSS BLUE SHIELD