Provider Demographics
NPI:1831476142
Name:MARK EDWARD SCROGGINS, M.D. P.A.
Entity Type:Organization
Organization Name:MARK EDWARD SCROGGINS, M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:SCROGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-283-8366
Mailing Address - Street 1:2612 HARWOOD RD STE A
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-8308
Mailing Address - Country:US
Mailing Address - Phone:817-283-8366
Mailing Address - Fax:817-283-8466
Practice Address - Street 1:2612 HARWOOD RD STE A
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-8308
Practice Address - Country:US
Practice Address - Phone:817-283-8366
Practice Address - Fax:817-283-8466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-15
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8892207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX032536701Medicaid
TXCM44OtherMEDICARE ID
TX032536701Medicaid