Provider Demographics
NPI:1376697193
Name:VICKNAIR, SCOTT PATRICK (CP,LP)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:PATRICK
Last Name:VICKNAIR
Suffix:
Gender:M
Credentials:CP,LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 331580
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78463-1580
Mailing Address - Country:US
Mailing Address - Phone:361-888-7752
Mailing Address - Fax:361-888-7424
Practice Address - Street 1:1326 SANTA FE ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2214
Practice Address - Country:US
Practice Address - Phone:361-888-7752
Practice Address - Fax:361-888-7424
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXCP003005224P00000X, 225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Not Answered225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0646290004Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER