Provider Demographics
NPI:1609847698
Name:SPILLMANN, SCOTT J (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:J
Last Name:SPILLMANN
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1481
Mailing Address - Street 2:
Mailing Address - City:YANCEYVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27379-1481
Mailing Address - Country:US
Mailing Address - Phone:336-337-3297
Mailing Address - Fax:
Practice Address - Street 1:326 TAYLOR DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-4188
Practice Address - Country:US
Practice Address - Phone:347-669-8574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC38697208100000X, 2083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
78929OtherBCBS
WV2007324000Medicaid
7607781OtherAETNA
NC8978929Medicaid
33243OtherPARTNERS
97556OtherMEDCOST
NC2013468AMedicare ID - Type Unspecified
D24646Medicare UPIN