Provider Demographics
NPI:1235125816
Name:SCOTT, PHILLIP CLAYTON (DO)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:CLAYTON
Last Name:SCOTT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 REID PKWY
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1157
Mailing Address - Country:US
Mailing Address - Phone:765-966-5949
Mailing Address - Fax:765-962-6268
Practice Address - Street 1:795 SIM HODGIN PKWY
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1928
Practice Address - Country:US
Practice Address - Phone:765-966-5949
Practice Address - Fax:765-962-6268
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02001334A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100389330Medicaid
IN000000603331OtherANTHEM
IN000000603331OtherANTHEM
F35572Medicare UPIN
IN259370CMedicare PIN