Provider Demographics
NPI:1083864151
Name:TARA SCOTT, PC
Entity Type:Organization
Organization Name:TARA SCOTT, PC
Other - Org Name:FOOT AND HEEL PAIN INSTITUTE OF MICHIGAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TARA
Authorized Official - Middle Name:LONG
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-557-6500
Mailing Address - Street 1:22250 PROVIDENCE DR
Mailing Address - Street 2:SUITE 608
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4825
Mailing Address - Country:US
Mailing Address - Phone:248-557-6500
Mailing Address - Fax:248-557-2781
Practice Address - Street 1:22250 PROVIDENCE DR
Practice Address - Street 2:SUITE 608
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4825
Practice Address - Country:US
Practice Address - Phone:248-557-6500
Practice Address - Fax:248-557-2781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-25
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITS001844213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIDB8502OtherRAILROAD MEDICARE
MI4856351640OtherBLUE CROSS BLUE SHIELD
MI0N81000001Medicare UPIN
MI4856351640OtherBLUE CROSS BLUE SHIELD