Provider Demographics
NPI:1659544989
Name:TIMOTHY A. SCROGGINS, MD, INC.
Entity Type:Organization
Organization Name:TIMOTHY A. SCROGGINS, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARLYN
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:SCROGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-648-9060
Mailing Address - Street 1:5666 RICHMAN RD
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:OH
Mailing Address - Zip Code:44275-9788
Mailing Address - Country:US
Mailing Address - Phone:330-648-9060
Mailing Address - Fax:330-667-1011
Practice Address - Street 1:110 S JACKSON ST
Practice Address - Street 2:SUITE 8
Practice Address - City:SPENCER
Practice Address - State:OH
Practice Address - Zip Code:44275-9569
Practice Address - Country:US
Practice Address - Phone:330-648-9060
Practice Address - Fax:330-667-1011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH35079345S305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDB2733OtherMEDICARE RAILROAD
OH000000314569OtherANTHEM
OH5938111OtherAETNA
OH454419230004OtherMEDICAL MUTUAL
OH2275121Medicaid
OH2275121Medicaid
OHTI9339571Medicare PIN