Provider Demographics
NPI:1407812613
Name:KIM SCOTT MD PLC
Entity Type:Organization
Organization Name:KIM SCOTT MD PLC
Other - Org Name:KIM E SCOTT, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-645-0800
Mailing Address - Street 1:PO BOX 95970
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-0970
Mailing Address - Country:US
Mailing Address - Phone:801-352-9500
Mailing Address - Fax:801-352-9502
Practice Address - Street 1:1790 SUN PEAK DR
Practice Address - Street 2:SUITE A101
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-6559
Practice Address - Country:US
Practice Address - Phone:435-645-0800
Practice Address - Fax:435-647-3003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000057112Medicare PIN
UTD37616Medicare UPIN