Provider Demographics
NPI:1760787840
Name:SCOT E. HAGADORN M.D., PC.
Entity Type:Organization
Organization Name:SCOT E. HAGADORN M.D., PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SCOT
Authorized Official - Middle Name:E
Authorized Official - Last Name:HAGADORN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-284-0493
Mailing Address - Street 1:PO BOX 41
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47308-0041
Mailing Address - Country:US
Mailing Address - Phone:765-284-0493
Mailing Address - Fax:765-284-2434
Practice Address - Street 1:1660 LAFAYETTE RD
Practice Address - Street 2:SUITE #100
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47933-4601
Practice Address - Country:US
Practice Address - Phone:765-359-1660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-20
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201010520Medicaid
IN201010520Medicaid