Provider Demographics
NPI:1538104716
Name:MICHAELA G SCOTT MD AND ASSOCIATES
Entity Type:Organization
Organization Name:MICHAELA G SCOTT MD AND ASSOCIATES
Other - Org Name:MICHAELA G SCOTT, MD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BEACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-770-4923
Mailing Address - Street 1:1460 36TH STREET
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-4849
Mailing Address - Country:US
Mailing Address - Phone:772-562-7777
Mailing Address - Fax:772-778-8117
Practice Address - Street 1:1460 36TH ST
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4849
Practice Address - Country:US
Practice Address - Phone:772-770-4923
Practice Address - Fax:772-778-8117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RH0003X
FL10D0276491291U00000X
FLME0025287332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
No291U00000XLaboratoriesClinical Medical Laboratory
No332900000XSuppliersNon-Pharmacy Dispensing SiteGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1017703OtherOTHER ID NUMBER-COMMERCIAL NUMBER
FL1017703OtherNCPDP NUMBER
FL21730OtherBCBS
FLG8850OtherBCBS
FL10D0276491OtherCLIA
FL262454100Medicaid
FLCN9289Medicare ID - Type UnspecifiedRR
FL262454100Medicaid
FL92096ZMedicare ID - Type Unspecified
FLG8850OtherBCBS
FL21730OtherBCBS
FLD59933Medicare UPIN
FL42988ZMedicare ID - Type UnspecifiedWTM
FL68857ZMedicare ID - Type UnspecifiedFMW
FL4113630001Medicare NSC