Provider Demographics
NPI: | 1548240427 |
---|---|
Name: | EMERICK, SCOTT (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | SCOTT |
Middle Name: | |
Last Name: | EMERICK |
Suffix: | |
Gender: | M |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 5133 N FM 1053 |
Mailing Address - Street 2: | |
Mailing Address - City: | FORT STOCKTON |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 79735-9457 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 606-595-0099 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 387 WEST IH 10 |
Practice Address - Street 2: | |
Practice Address - City: | FORT STOCKTON |
Practice Address - State: | TX |
Practice Address - Zip Code: | 79735-2700 |
Practice Address - Country: | US |
Practice Address - Phone: | 432-336-2058 |
Practice Address - Fax: | 432-336-4511 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-01-18 |
Last Update Date: | 2015-08-14 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | N3021 | 208600000X |
KY | 41683 | 208600000X |
IN | 01032402A | 208600000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 208600000X | Allopathic & Osteopathic Physicians | Surgery |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TX | 207800802 | Medicaid | |
IN | 100113650A | Medicaid | |
TX | TXB125915 | Medicare Oscar/Certification | |
D69496 | Medicare UPIN | ||
227950CCCC | Medicare ID - Type Unspecified | ||
IN | 100113650A | Medicaid |