Provider Demographics
NPI:1811015308
Name:SCOTT COMMUNITY CARE, PLLC
Entity Type:Organization
Organization Name:SCOTT COMMUNITY CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:JAYNE
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:LSW-I
Authorized Official - Phone:208-877-1444
Mailing Address - Street 1:PO BOX 307
Mailing Address - Street 2:
Mailing Address - City:DEARY
Mailing Address - State:ID
Mailing Address - Zip Code:83823-0307
Mailing Address - Country:US
Mailing Address - Phone:208-877-1444
Mailing Address - Fax:208-877-9004
Practice Address - Street 1:200 S ALMON ST STE 101
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-2098
Practice Address - Country:US
Practice Address - Phone:208-877-1444
Practice Address - Fax:208-877-9004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID8058915261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID805891500Medicaid