Provider Demographics
NPI:1235423393
Name:BELLISTON, SCOTT M (DO)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:M
Last Name:BELLISTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:3901 RAINBOW BLVD
Mailing Address - Street 2:MS 2012
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66103-2937
Mailing Address - Country:US
Mailing Address - Phone:913-588-6970
Mailing Address - Fax:913-588-6965
Practice Address - Street 1:700 1ST AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-1802
Practice Address - Country:US
Practice Address - Phone:701-234-2000
Practice Address - Fax:701-234-4134
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2022-03-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS94-076862084N0400X
ND167492084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology