Provider Demographics
NPI:1578656633
Name:SCOTT & KELLY CONROE
Entity Type:Organization
Organization Name:SCOTT & KELLY CONROE
Other - Org Name:COMFORT KEEPERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:WYATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-935-6511
Mailing Address - Street 1:803 SAM HOUSTON DR
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-4548
Mailing Address - Country:US
Mailing Address - Phone:361-578-7778
Mailing Address - Fax:361-578-5248
Practice Address - Street 1:14887 HIGHWAY 105 W
Practice Address - Street 2:SUITE #205
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77356-5672
Practice Address - Country:US
Practice Address - Phone:936-582-1235
Practice Address - Fax:936-582-1237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty