Provider Demographics
NPI:1275183220
Name:FLYNN, SCOTT PATRICK
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:PATRICK
Last Name:FLYNN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1884 10 MILE RD NE
Mailing Address - Street 2:
Mailing Address - City:COMSTOCK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:49321-9669
Mailing Address - Country:US
Mailing Address - Phone:616-881-3615
Mailing Address - Fax:
Practice Address - Street 1:1884 10 MILE RD NE
Practice Address - Street 2:
Practice Address - City:COMSTOCK PARK
Practice Address - State:MI
Practice Address - Zip Code:49321-9669
Practice Address - Country:US
Practice Address - Phone:616-881-3615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies