Provider Demographics
NPI:1750469706
Name:ROUSH, SCOTT F (DO)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:F
Last Name:ROUSH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 PORTER WAGONER BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-1828
Mailing Address - Country:US
Mailing Address - Phone:417-255-8645
Mailing Address - Fax:417-255-8649
Practice Address - Street 1:1307 PORTER WAGONER BLVD
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-1828
Practice Address - Country:US
Practice Address - Phone:417-255-8645
Practice Address - Fax:417-255-8649
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002015295207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO678188OtherHEALTHLINK
MO192322OtherBLUE CROSS BLUE SHIELD
MO200447514Medicaid
MO000092454Medicare ID - Type Unspecified
MO200447514Medicaid