Provider Demographics
NPI:1245390764
Name:RENS, SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:RENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 9TH ST SE
Mailing Address - Street 2:
Mailing Address - City:SIOUX CENTER
Mailing Address - State:IA
Mailing Address - Zip Code:51250-2501
Mailing Address - Country:US
Mailing Address - Phone:712-722-2609
Mailing Address - Fax:712-439-1264
Practice Address - Street 1:807 MAIN STREET
Practice Address - Street 2:
Practice Address - City:HULL
Practice Address - State:IA
Practice Address - Zip Code:51239
Practice Address - Country:US
Practice Address - Phone:712-439-1315
Practice Address - Fax:712-439-1264
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA29361207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA8085472Medicaid
IAI11563Medicare PIN
IA8085472Medicaid