Provider Demographics
NPI:1306368402
Name:SCRODCO PLLC
Entity Type:Organization
Organization Name:SCRODCO PLLC
Other - Org Name:SOUTHWEST FOOT & ANKLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGNESEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:435-628-5690
Mailing Address - Street 1:676 S BLUFF ST STE 205
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-3568
Mailing Address - Country:US
Mailing Address - Phone:435-628-5690
Mailing Address - Fax:435-628-5805
Practice Address - Street 1:676 S BLUFF ST STE 205
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3568
Practice Address - Country:US
Practice Address - Phone:435-628-5690
Practice Address - Fax:435-628-5805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty