Provider Demographics
NPI:1922133214
Name:SCAMEHORN, CAROL ANN (PA)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:SCAMEHORN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9450 S SAGINAW RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-8206
Mailing Address - Country:US
Mailing Address - Phone:810-603-9391
Mailing Address - Fax:810-603-9394
Practice Address - Street 1:9450 S SAGINAW RD
Practice Address - Street 2:SUITE G
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-8206
Practice Address - Country:US
Practice Address - Phone:810-603-9391
Practice Address - Fax:810-603-9394
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601002827363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN83660003Medicare PIN