Provider Demographics
NPI:1508228560
Name:ROGER SCOTT HERRIN INC
Entity Type:Organization
Organization Name:ROGER SCOTT HERRIN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:HERRIN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:256-851-2807
Mailing Address - Street 1:13008 ASTALOT DR SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35803-1802
Mailing Address - Country:US
Mailing Address - Phone:256-851-2807
Mailing Address - Fax:256-841-2967
Practice Address - Street 1:2701 MERIDIAN ST N
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35811-1845
Practice Address - Country:US
Practice Address - Phone:256-851-2807
Practice Address - Fax:256-851-2967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-28
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL363L00000XMedicaid