Provider Demographics
NPI:1699472399
Name:SCOTT CITY MEDICAL CLINIC LLC
Entity type:Organization
Organization Name:SCOTT CITY MEDICAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:W
Authorized Official - Last Name:MCCALLUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-264-0042
Mailing Address - Street 1:2102 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SCOTT CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63780-1337
Mailing Address - Country:US
Mailing Address - Phone:573-264-0042
Mailing Address - Fax:573-264-0087
Practice Address - Street 1:2102 MAIN ST
Practice Address - Street 2:
Practice Address - City:SCOTT CITY
Practice Address - State:MO
Practice Address - Zip Code:63780-1337
Practice Address - Country:US
Practice Address - Phone:573-264-0042
Practice Address - Fax:573-264-0087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center