Provider Demographics
NPI:1942395694
Name:SCOTT E VINCENT M. D. , P. C.
Entity Type:Organization
Organization Name:SCOTT E VINCENT M. D. , P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:E
Authorized Official - Last Name:VINCENT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-242-3641
Mailing Address - Street 1:601 CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-2041
Mailing Address - Country:US
Mailing Address - Phone:970-242-3641
Mailing Address - Fax:970-256-0945
Practice Address - Street 1:601 CENTER AVE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-2041
Practice Address - Country:US
Practice Address - Phone:970-242-3641
Practice Address - Fax:970-256-0945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO33850261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04021689Medicaid
COC92451Medicare ID - Type Unspecified
CO04021689Medicaid