Provider Demographics
NPI:1528029683
Name:ATTENTUS OF SCOTT COUNTY, LLC
Entity Type:Organization
Organization Name:ATTENTUS OF SCOTT COUNTY, LLC
Other - Org Name:SCOTT COUNTY PRIMARY CARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BOM
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:M
Authorized Official - Last Name:CROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-569-8521
Mailing Address - Street 1:PO BOX 4609
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:TN
Mailing Address - Zip Code:37841-4609
Mailing Address - Country:US
Mailing Address - Phone:423-569-7918
Mailing Address - Fax:423-569-8640
Practice Address - Street 1:20445 ALBERTA ST
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:TN
Practice Address - Zip Code:37841-3509
Practice Address - Country:US
Practice Address - Phone:423-569-6396
Practice Address - Fax:423-569-8640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3728761Medicaid
KY78904331Medicaid
DC7935OtherMEDICARE RAILROAD
KY357349OtherANTHEM BCBS GROUP #
KY78904331Medicaid