Provider Demographics
NPI:1336176858
Name:TIMOTHY J SCOTT DPM PC
Entity Type:Organization
Organization Name:TIMOTHY J SCOTT DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:814-226-0717
Mailing Address - Street 1:22905 ROUTE 68
Mailing Address - Street 2:
Mailing Address - City:CLARION
Mailing Address - State:PA
Mailing Address - Zip Code:16214-8557
Mailing Address - Country:US
Mailing Address - Phone:814-226-0717
Mailing Address - Fax:814-226-5336
Practice Address - Street 1:22905 ROUTE 68
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214-8557
Practice Address - Country:US
Practice Address - Phone:814-226-0717
Practice Address - Fax:814-226-5336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004077L213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA4748580001OtherDME
PA00162263100008Medicaid
PA0016226310007Medicaid
PA480027239OtherRAILROAD MEDICARE
PA136177OtherMEDICARE ID TYPE UNSPECIFIED
PA4748580001OtherDME
PA136177OtherMEDICARE ID TYPE UNSPECIFIED
PA00162263100008Medicaid
PA4748580001Medicare NSC
PA824554Medicare ID - Type Unspecified