Provider Demographics
NPI:1255427738
Name:MCINTOSH, SCOTT E (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:E
Last Name:MCINTOSH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 ARAPEEN DR
Mailing Address - Street 2:STE #110
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-1250
Mailing Address - Country:US
Mailing Address - Phone:801-582-4268
Mailing Address - Fax:801-582-4269
Practice Address - Street 1:540 ARAPEEN DR, STE #110
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108
Practice Address - Country:US
Practice Address - Phone:801-582-4268
Practice Address - Fax:801-582-4269
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2021-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5892280-1205207PE0004X, 207PE0005X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT134366OtherAHCCCS MEDICAID
UTD6308Medicaid
UT90073OtherHEALTHY U MEDICAID
UT58922801201001OtherBCBS
UT90509OtherPEHP
UTP00387144OtherRAILROAD MEDICARE
UT300528OtherALTIUS
UTA007OtherTRICARE
UTMD542OKOtherALASKA MEDICAID
UT300528OtherALTIUS
UTD6308Medicaid