Provider Demographics
NPI:1942364476
Name:MICHAELA G SCOTT MD AND ASSOCIATES
Entity Type:Organization
Organization Name:MICHAELA G SCOTT MD AND ASSOCIATES
Other - Org Name:MICHAELA G SCOTT, MD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BEACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-770-4923
Mailing Address - Street 1:1460 36TH ST
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-4849
Mailing Address - Country:US
Mailing Address - Phone:772-562-7777
Mailing Address - Fax:772-778-8117
Practice Address - Street 1:1460 36TH ST
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4849
Practice Address - Country:US
Practice Address - Phone:772-562-7777
Practice Address - Fax:772-778-8117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0025287332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC08501402OtherSUBMITTER ID
FL92096ZMedicare ID - Type UnspecifiedPROVIDER
FLC08501402OtherSUBMITTER ID
FL42988ZMedicare ID - Type UnspecifiedWTM PROVIDER
FL68857ZMedicare ID - Type UnspecifiedFMW PROVIDER