Provider Demographics
NPI:1497135800
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 1:862 MEINECKE AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-1721
Mailing Address - Country:US
Mailing Address - Phone:805-543-1509
Mailing Address - Fax:805-543-1513
Practice Address - Street 1:862 MEINECKE AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-1721
Practice Address - Country:US
Practice Address - Phone:805-543-1509
Practice Address - Fax:805-543-1513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-02
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3834213ES0103X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWE2834CMedicaid
CAWE2834CMedicaid