Provider Demographics
NPI:1649595802
Name:SCOTT A. BRANDT, MD, PC
Entity type:Organization
Organization Name:SCOTT A. BRANDT, MD, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:DOOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-689-2380
Mailing Address - Street 1:7447 E BERRY AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2142
Mailing Address - Country:US
Mailing Address - Phone:303-689-2300
Mailing Address - Fax:
Practice Address - Street 1:7075 CAMPUS DR STE 102
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-6524
Practice Address - Country:US
Practice Address - Phone:303-689-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-31
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36941261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
COF68027Medicare UPIN
COC806955Medicare PIN