Provider Demographics
NPI:1568425106
Name:SIMS, SCOTT C (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:C
Last Name:SIMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 E 2ND AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1778
Mailing Address - Country:US
Mailing Address - Phone:270-843-5114
Mailing Address - Fax:270-745-1230
Practice Address - Street 1:720 E 2ND AVE
Practice Address - Street 2:SUITE #203
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-1778
Practice Address - Country:US
Practice Address - Phone:270-843-5114
Practice Address - Fax:270-745-1230
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY24986207RN0300X
NC2022-02825207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYC76008Medicare UPIN