Provider Demographics
NPI:1700827193
Name:SCOTT, JANE (MD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 ADDISON AVE W
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-5491
Mailing Address - Country:US
Mailing Address - Phone:208-733-4343
Mailing Address - Fax:208-734-9941
Practice Address - Street 1:630 ADDISON AVE W
Practice Address - Street 2:SUITE 100
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5491
Practice Address - Country:US
Practice Address - Phone:208-733-4343
Practice Address - Fax:208-734-9941
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2007-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM7581208000000X, 2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDF39427Medicare UPIN
ID1105537Medicare ID - Type UnspecifiedMEDICARE NUMBER