Provider Demographics
NPI:1043544505
Name:JAMES T SCOTT MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:JAMES T SCOTT MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-883-8153
Mailing Address - Street 1:12011 SAN VICENTE BLVD
Mailing Address - Street 2:408
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-4926
Mailing Address - Country:US
Mailing Address - Phone:310-883-8153
Mailing Address - Fax:310-454-7351
Practice Address - Street 1:12011 SAN VICENTE BLVD
Practice Address - Street 2:408
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-4926
Practice Address - Country:US
Practice Address - Phone:310-883-8153
Practice Address - Fax:310-454-7351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-30
Last Update Date:2010-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG217322084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G217320Medicaid
CADE555AOtherMEDICARE GROUP PTAN
CA1770667578OtherINDIVIDUAL NPI
CADE556ZOtherMEDICARE INDIVIDUAL PTAN
CADE555AOtherMEDICARE GROUP PTAN