Provider Demographics
NPI:1952851594
Name:SCOTT, NORRIS VANN III
Entity Type:Individual
Prefix:
First Name:NORRIS
Middle Name:VANN
Last Name:SCOTT
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11608 S 100TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:BIXBY
Mailing Address - State:OK
Mailing Address - Zip Code:74008-2226
Mailing Address - Country:US
Mailing Address - Phone:918-813-8419
Mailing Address - Fax:
Practice Address - Street 1:3606 N MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74106-6459
Practice Address - Country:US
Practice Address - Phone:918-949-4212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-06
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator