Provider Demographics
NPI:1598722951
Name:SCOTT D ALLEN MD & ASSOCIATES PC
Entity Type:Organization
Organization Name:SCOTT D ALLEN MD & ASSOCIATES PC
Other - Org Name:NEW MEXICO EYE CLINIC OF FARMINGTON
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:D
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-325-5021
Mailing Address - Street 1:2300 E 30TH ST
Mailing Address - Street 2:STE 105
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-8990
Mailing Address - Country:US
Mailing Address - Phone:505-327-0406
Mailing Address - Fax:505-326-4691
Practice Address - Street 1:2300 E 30TH ST
Practice Address - Street 2:STE 105
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-8990
Practice Address - Country:US
Practice Address - Phone:505-327-0406
Practice Address - Fax:505-326-4691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM95-172207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
201000176OtherPRESBYTERIAN HEALTH PLAN
NMA2357Medicaid
NMCJ4675OtherRAILROAD MEDICARE
NMA2357Medicaid
=========87401A003WEOtherTRICARE