Provider Demographics
NPI:1477523645
Name:MATTSON, SCOTT E (DO)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:E
Last Name:MATTSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7411 HOPE DR STE C
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815-5687
Practice Address - Country:US
Practice Address - Phone:260-234-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02001461A207RC0000X
IN02001461207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
060057216OtherRAILROAD
IN200207560Medicaid
INP00752848OtherRAILROAD
IN000000087427OtherANTHEM
OH2123446Medicaid
OH2123446Medicaid
OH2123446Medicaid
IN260690RROtherMEDICARE