Provider Demographics
NPI:1255482683
Name:ASTLEY, SCOTT MICHAEL (PA-C)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:MICHAEL
Last Name:ASTLEY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1789 S BROADWAY AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-3800
Mailing Address - Country:US
Mailing Address - Phone:970-324-9722
Mailing Address - Fax:208-482-5505
Practice Address - Street 1:2121 E HARMONY RD
Practice Address - Street 2:SUITE 370
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-3400
Practice Address - Country:US
Practice Address - Phone:970-221-2290
Practice Address - Fax:970-221-2293
Is Sole Proprietor?:No
Enumeration Date:2007-01-14
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO2365363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP00750757OtherRR MEDICARE
CO82377774Medicaid
COQ76206Medicare UPIN
COP00750757OtherRR MEDICARE