Provider Demographics
NPI:1760472906
Name:SADLER, SCOTT MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:MICHAEL
Last Name:SADLER
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 1:294 SUMMAR DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-3915
Mailing Address - Country:US
Mailing Address - Phone:731-423-1932
Mailing Address - Fax:731-410-0367
Practice Address - Street 1:294 SUMMAR DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-3915
Practice Address - Country:US
Practice Address - Phone:731-423-1932
Practice Address - Fax:731-410-0367
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30952207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN27437OtherTLC
TN3432488Medicaid
TN626001636OtherHEALTH PARTNERS
TN3832482Medicaid
TN4055373OtherBLUE CROSS BLUE SHIELD
TNP00034972OtherRAILROAD MEDICARE
TN626001636OtherUSA MANAGED CARE
TN626001636OtherUNITED HEALTHCARE
TN152665OtherUNISON
TN4625281OtherCIGNA
TNP00034972OtherRAILROAD MEDICARE
TNG85390Medicare UPIN
TN3832480Medicare ID - Type Unspecified