Provider Demographics
NPI:1245388891
Name:RICHARDS, SCOTT DENNIS (PA-C)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:DENNIS
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 RADIO HILL ROAD
Mailing Address - Street 2:MEL LEAMAN FREE CLINIC AT EMORY & HENRY COLLEGE
Mailing Address - City:MARION
Mailing Address - State:VA
Mailing Address - Zip Code:24354
Mailing Address - Country:US
Mailing Address - Phone:276-781-2090
Mailing Address - Fax:207-783-6660
Practice Address - Street 1:601 RADIO HILL ROAD
Practice Address - Street 2:MEL LEAMAN FREE CLINIC AT EMORY & HENRY COLLEGE
Practice Address - City:MARION
Practice Address - State:VA
Practice Address - Zip Code:24354
Practice Address - Country:US
Practice Address - Phone:276-781-2090
Practice Address - Fax:207-330-3955
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MEPA-138363A00000X
MEPAN686363AM0700X
VA0110004884363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME336160099Medicaid
MEP11818Medicare UPIN
MEAP1304Medicare ID - Type Unspecified