Provider Demographics
NPI:1922370808
Name:SCOTT SPORTS MED
Entity Type:Organization
Organization Name:SCOTT SPORTS MED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-855-8450
Mailing Address - Street 1:6918 GUNN HWY
Mailing Address - Street 2:STE C
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-3853
Mailing Address - Country:US
Mailing Address - Phone:813-855-8450
Mailing Address - Fax:813-855-7540
Practice Address - Street 1:6918 GUNN HWY
Practice Address - Street 2:STE C
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-3853
Practice Address - Country:US
Practice Address - Phone:813-855-8450
Practice Address - Fax:813-855-7540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty