Provider Demographics
NPI:1417056102
Name:SCOTT H ANDREW DPM LLC
Entity Type:Organization
Organization Name:SCOTT H ANDREW DPM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:H
Authorized Official - Last Name:ANDREW
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:513-745-9988
Mailing Address - Street 1:6200 PLEASANT AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-4670
Mailing Address - Country:US
Mailing Address - Phone:513-745-9988
Mailing Address - Fax:513-745-0296
Practice Address - Street 1:9030 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-7741
Practice Address - Country:US
Practice Address - Phone:513-745-9988
Practice Address - Fax:513-745-0296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003100213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2453858Medicaid
OHDD8318OtherRAILROAD MEDICARE
OHDD8318OtherRAILROAD MEDICARE
OH2453858Medicaid