Provider Demographics
NPI:1063486876
Name:SCOTT J.M. LIM, D.O. LLC
Entity Type:Organization
Organization Name:SCOTT J.M. LIM, D.O. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:JIT-MENG
Authorized Official - Last Name:LIM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:814-836-1300
Mailing Address - Street 1:3243 W 26TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-2507
Mailing Address - Country:US
Mailing Address - Phone:814-836-1300
Mailing Address - Fax:814-836-1346
Practice Address - Street 1:3243 W 26TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-2507
Practice Address - Country:US
Practice Address - Phone:814-836-1300
Practice Address - Fax:814-836-1346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006153L207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1500347OtherGATEWAY MA PROV ID
PA412984OtherHIGHMARK BLUE SHIELD ID
PA07003058OtherRAILROAD MEDICARE PROV ID
PA1011067500001Medicaid
PAC33648Medicare UPIN
PA1011067500001Medicaid