Provider Demographics
NPI:1750448528
Name:DAVIS, SCOTT STEVEN I (PA-C)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:STEVEN
Last Name:DAVIS
Suffix:I
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 JOEL DRIVE
Mailing Address - Street 2:BLANCHFIELD ARMY COMMUNITY HOSPITAL
Mailing Address - City:FORT CAMPBELL
Mailing Address - State:KY
Mailing Address - Zip Code:42223-5349
Mailing Address - Country:US
Mailing Address - Phone:270-798-8727
Mailing Address - Fax:270-956-0180
Practice Address - Street 1:650 JOEL DRIVE
Practice Address - Street 2:BLANCHFIELD ARMY COMMUNITY HOSPITAL
Practice Address - City:FORT CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223-5349
Practice Address - Country:US
Practice Address - Phone:270-798-8727
Practice Address - Fax:270-956-0180
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1066134363A00000X
TXPA06216363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX282394002Medicaid
TXTXB123968Medicare PIN
TXTXB123962Medicare PIN
TNVA000Medicare UPIN
TXTXB1239626Medicare PIN