Provider Demographics
NPI:1275890840
Name:SCOT C. CALLAHAN, M.D. , P.C.
Entity Type:Organization
Organization Name:SCOT C. CALLAHAN, M.D. , P.C.
Other - Org Name:CALLAHAN ENT & FACIAL PLASTICS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOT
Authorized Official - Middle Name:C
Authorized Official - Last Name:CALLAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-393-6673
Mailing Address - Street 1:101 E BRUNSON ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-2526
Mailing Address - Country:US
Mailing Address - Phone:334-393-6673
Mailing Address - Fax:334-347-9599
Practice Address - Street 1:101 E BRUNSON ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-2526
Practice Address - Country:US
Practice Address - Phone:334-393-6673
Practice Address - Fax:334-347-9599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-19
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18006207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000077626Medicaid
1023096427OtherNPI