Provider Demographics
NPI:1124479126
Name:MASON, SCOTT P
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:P
Last Name:MASON
Suffix:
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 1:632 ADAMS ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-2174
Mailing Address - Country:US
Mailing Address - Phone:270-793-9170
Mailing Address - Fax:866-407-2501
Practice Address - Street 1:632 ADAMS ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-2174
Practice Address - Country:US
Practice Address - Phone:270-793-9170
Practice Address - Fax:866-407-2501
Is Sole Proprietor?:No
Enumeration Date:2016-06-30
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor