Provider Demographics
NPI:1932319928
Name:SCOTT TERRY FEMALE HEALTH ASSOCIATES, PC
Entity Type:Organization
Organization Name:SCOTT TERRY FEMALE HEALTH ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TONI
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-895-8497
Mailing Address - Street 1:430 E 162ND ST
Mailing Address - Street 2:STE 300
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-2258
Mailing Address - Country:US
Mailing Address - Phone:708-895-8497
Mailing Address - Fax:
Practice Address - Street 1:20325 S GRACELAND LN
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-9047
Practice Address - Country:US
Practice Address - Phone:708-895-8497
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036102112174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036102112Medicaid
ILH56481Medicare UPIN