Provider Demographics
NPI:1588040208
Name:MCEWAN, SCOTT
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:
Last Name:MCEWAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6041 VILLAGE BEND DR
Mailing Address - Street 2:1105
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-3600
Mailing Address - Country:US
Mailing Address - Phone:214-288-2810
Mailing Address - Fax:469-283-0603
Practice Address - Street 1:6041 VILLAGE BEND DR
Practice Address - Street 2:1105
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-3600
Practice Address - Country:US
Practice Address - Phone:214-288-2810
Practice Address - Fax:469-283-0603
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXCSR1661343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)