Provider Demographics
NPI:1104007467
Name:SCOTT J ARBAUGH MD
Entity Type:Organization
Organization Name:SCOTT J ARBAUGH MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:J
Authorized Official - Last Name:ARBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-695-4554
Mailing Address - Street 1:1001 BOARDWALK SPRINGS PL
Mailing Address - Street 2:SUITE 111A
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-4778
Mailing Address - Country:US
Mailing Address - Phone:636-695-4554
Mailing Address - Fax:636-695-3099
Practice Address - Street 1:1 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-6722
Practice Address - Country:US
Practice Address - Phone:636-695-4554
Practice Address - Fax:636-695-3099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK159153OtherPROVIDER NUMBER
IL211318Medicare PIN