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
StateLicense IDTaxonomies
TXN3021208600000X
KY41683208600000X
IN01032402A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX207800802Medicaid
IN100113650AMedicaid
TXTXB125915Medicare Oscar/Certification
D69496Medicare UPIN
227950CCCCMedicare ID - Type Unspecified
IN100113650AMedicaid