Provider Demographics
NPI:1114012630
Name:HURST, SCOTT NATHAN (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:NATHAN
Last Name:HURST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 NORTH CENTER ST
Mailing Address - Street 2:#800
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-7406
Mailing Address - Country:US
Mailing Address - Phone:801-990-1911
Mailing Address - Fax:801-990-1912
Practice Address - Street 1:5121 S COTTONWOOD STREET
Practice Address - Street 2:INTERMOUNTAIN MEDICAL CENTER
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84157
Practice Address - Country:US
Practice Address - Phone:801-507-5248
Practice Address - Fax:801-733-5618
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT83-169265-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTTPRA08325OtherMOLINA
UT107005094101OtherIHC
UT22942OtherDESERET MUTUAL
UT37793OtherPEHP
UT870545614HU1OtherEDUCATORS MUTUAL
UT1502954OtherUMWA
ID002037800Medicaid
NV100501268Medicaid
AZ822389Medicaid
UTQM0000075886OtherALTIUS
WY105261600Medicaid
UT53244OtherHEALTHY U
UT8597445OtherWORKERS COMP
UT2090168OtherUNITED HEALTHCARE
UTQM0000075886OtherALTIUS
UT050041409Medicare ID - Type UnspecifiedRAILROAD MEDICARE
AZ822389Medicaid