Provider Demographics
NPI:1720180888
Name:GEORGE, JOHN SCOTT (BC-HIS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:SCOTT
Last Name:GEORGE
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:SCOTT
Other - Middle Name:
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BC-HIS
Mailing Address - Street 1:1050 W HAYWARD DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:MO
Mailing Address - Zip Code:65712-6329
Mailing Address - Country:US
Mailing Address - Phone:417-466-7184
Mailing Address - Fax:417-466-4081
Practice Address - Street 1:1050 W HAYWARD DR
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:MO
Practice Address - Zip Code:65712-6329
Practice Address - Country:US
Practice Address - Phone:417-466-7184
Practice Address - Fax:417-466-4081
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO001197237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist