Provider Demographics
NPI:1003864547
Name:MITCHELL, SCOTT E (PA-C)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:E
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4015 GATEWAY BLVD STE 2120
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-9460
Mailing Address - Country:US
Mailing Address - Phone:812-842-0907
Mailing Address - Fax:812-464-0536
Practice Address - Street 1:4015 GATEWAY BLVD
Practice Address - Street 2:SUITE 2120
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-8925
Practice Address - Country:US
Practice Address - Phone:812-842-0907
Practice Address - Fax:812-464-0536
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000118363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
179627OtherHEALTHLINK
000000108475OtherANTHEM
KY9500121000Medicaid
KY9500121000Medicaid
179627OtherHEALTHLINK
IN532500WMedicare ID - Type UnspecifiedIN MCR