Provider Demographics
NPI:1679657415
Name:SCATES, KYLE W (MD)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:W
Last Name:SCATES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646
Mailing Address - Country:US
Mailing Address - Phone:864-227-6741
Mailing Address - Fax:864-227-2026
Practice Address - Street 1:1015 SPRING ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646
Practice Address - Country:US
Practice Address - Phone:864-227-6741
Practice Address - Fax:864-227-2026
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23145207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPA1122Medicaid
H57291Medicare UPIN
SCPA1122Medicaid