Provider Demographics
NPI:1487648697
Name:SCOTT E ADAMS DPM INC
Entity Type:Organization
Organization Name:SCOTT E ADAMS DPM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:E
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:805-481-0881
Mailing Address - Street 1:310 S HALCYON RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-3872
Mailing Address - Country:US
Mailing Address - Phone:805-481-0881
Mailing Address - Fax:805-481-0835
Practice Address - Street 1:310 S HALCYON RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-3872
Practice Address - Country:US
Practice Address - Phone:805-481-0881
Practice Address - Fax:805-481-0835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40580213E00000X
CA0600250001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADG7094OtherRAILRIOAD MEDICARE
CAZZZ50260YOtherBLUE SHIELD
CAGRE001760Medicaid
CAGRE001760Medicaid
CA5854090001Medicare NSC