Provider Demographics
NPI:1235574500
Name:SCOTT A HANNAN MD LLC
Entity Type:Organization
Organization Name:SCOTT A HANNAN MD LLC
Other - Org Name:BUCKEYE FAMILY HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:I
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-601-0999
Mailing Address - Street 1:3477 COMMERCE PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-7126
Mailing Address - Country:US
Mailing Address - Phone:330-601-0999
Mailing Address - Fax:330-601-0935
Practice Address - Street 1:3477 COMMERCE PARKWAY
Practice Address - Street 2:SUITE A
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-6109
Practice Address - Country:US
Practice Address - Phone:330-601-0999
Practice Address - Fax:330-601-0935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-01
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35080332207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2341942Medicaid
OH2341942Medicaid