Provider Demographics
NPI:1184759888
Name:SCOTT MCMENEMY MD PA
Entity type:Organization
Organization Name:SCOTT MCMENEMY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MCMENEMY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-980-3376
Mailing Address - Street 1:3425 HIGHWAY 6
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4512
Mailing Address - Country:US
Mailing Address - Phone:281-980-3376
Mailing Address - Fax:281-265-5548
Practice Address - Street 1:3425 HIGHWAY 6
Practice Address - Street 2:SUITE 105
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4512
Practice Address - Country:US
Practice Address - Phone:281-980-3376
Practice Address - Fax:281-265-5548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8275207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00A94QOtherBLUE CROSS BLUE SHIELD TX
TXP00038236OtherRAIL ROAD MEDICARE
TXP00038236OtherRAIL ROAD MEDICARE
TXB24779Medicare UPIN