Provider Demographics
NPI:1093332421
Name:SCOTT, KEVIN G (MBA, RDCS, RVT)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:G
Last Name:SCOTT
Suffix:
Gender:M
Credentials:MBA, RDCS, RVT
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1700 S CAMPBELL AVE STE J
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-2000
Mailing Address - Country:US
Mailing Address - Phone:417-209-5700
Mailing Address - Fax:833-792-4156
Practice Address - Street 1:639A S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:MO
Practice Address - Zip Code:65536-3618
Practice Address - Country:US
Practice Address - Phone:417-209-3785
Practice Address - Fax:833-792-4156
Is Sole Proprietor?:No
Enumeration Date:2020-07-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0136482471V0105X, 246XS1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography
No2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular Sonography