Provider Demographics
NPI:1184846636
Name:ZOLLETT MEDICAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:ZOLLETT MEDICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:ZOLLETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-424-1291
Mailing Address - Street 1:200 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 490
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45005-5200
Mailing Address - Country:US
Mailing Address - Phone:513-424-1291
Mailing Address - Fax:513-424-9422
Practice Address - Street 1:200 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 490
Practice Address - City:FRANKLIN
Practice Address - State:OH
Practice Address - Zip Code:45005-5200
Practice Address - Country:US
Practice Address - Phone:513-424-1291
Practice Address - Fax:513-424-9422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9286691Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER