Provider Demographics
NPI:1295601128
Name:RUCKO-SCADUTO, ALEXANDER
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:RUCKO-SCADUTO
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 1:807 SCENIC DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59912-4344
Mailing Address - Country:US
Mailing Address - Phone:406-857-8091
Mailing Address - Fax:
Practice Address - Street 1:9549 US ROUTE 2
Practice Address - Street 2:
Practice Address - City:MARTIN CITY
Practice Address - State:MT
Practice Address - Zip Code:59926
Practice Address - Country:US
Practice Address - Phone:406-857-8091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-16
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-BHPS-CRT-81513175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist