Provider Demographics
NPI:1033376595
Name:REISING, SCOTT F (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:F
Last Name:REISING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 W. 4TH STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501
Mailing Address - Country:US
Mailing Address - Phone:931-372-0405
Mailing Address - Fax:931-372-0463
Practice Address - Street 1:228 W. 4TH STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501
Practice Address - Country:US
Practice Address - Phone:931-372-0405
Practice Address - Fax:931-372-0463
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2017-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN47573207R00000X
TNMD47573207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4310402OtherBCBS
TN1524849Medicaid
KY7100231230Medicaid
TN1524849Medicaid