Provider Demographics
NPI:1841229846
Name:MCCUSKEY, SCOTT CASEY (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:CASEY
Last Name:MCCUSKEY
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:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250-0189
Mailing Address - Country:US
Mailing Address - Phone:812-801-0848
Mailing Address - Fax:812-801-0773
Practice Address - Street 1:1373 E STATE ROAD 62
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250-7328
Practice Address - Country:US
Practice Address - Phone:812-801-0848
Practice Address - Fax:812-801-0773
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01049529207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
1084621OtherPASSPORT KY MEDICAID
200034110OtherMEDICARE RAILROAD
IN200194530AMedicaid
KY64799604Medicaid
IN000000111701OtherANTHEM BCBS
KY2435685000OtherPASSPORT ADVANTAGE
4082034OtherAETNA
IN410814POtherSIHO
IN412840WMedicare ID - Type Unspecified
A14419Medicare UPIN
KY0875802Medicare ID - Type Unspecified
IN200034110Medicare PIN
4082034OtherAETNA