Provider Demographics
NPI:1891119913
Name:SCOTT ROSSOW, DO, PC
Entity type:Organization
Organization Name:SCOTT ROSSOW, DO, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROSSOW
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:417-339-9800
Mailing Address - Street 1:2209 ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-1932
Mailing Address - Country:US
Mailing Address - Phone:417-339-9800
Mailing Address - Fax:
Practice Address - Street 1:2209 ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-1932
Practice Address - Country:US
Practice Address - Phone:417-339-9800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-10
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20001688102085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty