Provider Demographics
NPI:1598913022
Name:BRAMBLE, SCOTT M (PA)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:M
Last Name:BRAMBLE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1932 ALCOA HWY
Mailing Address - Street 2:SUITE 360
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1527
Mailing Address - Country:US
Mailing Address - Phone:865-546-2663
Mailing Address - Fax:865-546-9047
Practice Address - Street 1:1932 ALCOA HWY
Practice Address - Street 2:SUITE 360
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1527
Practice Address - Country:US
Practice Address - Phone:865-546-2663
Practice Address - Fax:865-546-9047
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1881363AS0400X, 363A00000X
UT7098483-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00883990OtherRR MEDICARE
TN1520996Medicaid
TN4274862OtherBLUECROSS BLUESHIELD
TN4274863OtherBLUECROSS BLUESHIELD - AT SURGERY
UT000066408Medicare PIN
TNP00883990OtherRR MEDICARE
TN4274863OtherBLUECROSS BLUESHIELD - AT SURGERY