Provider Demographics
NPI:1215018205
Name:CRYDER, SCOTT J (PA-C)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:J
Last Name:CRYDER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 228
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:OH
Mailing Address - Zip Code:43138-0228
Mailing Address - Country:US
Mailing Address - Phone:740-380-4181
Mailing Address - Fax:740-385-0865
Practice Address - Street 1:819 STATE ROUTE 664 N
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:OH
Practice Address - Zip Code:43138
Practice Address - Country:US
Practice Address - Phone:740-380-8140
Practice Address - Fax:740-380-8150
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50002332363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2330150Medicaid
OH000000547134OtherANTHEM
OH2553018OtherUHC
OHCRPA27722Medicare PIN