Provider Demographics
NPI:1700925088
Name:DWIGHT E SCOTT DPM INC
Entity Type:Organization
Organization Name:DWIGHT E SCOTT DPM INC
Other - Org Name:DWIGHT E SCOTT DPM
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:216-426-9314
Mailing Address - Street 1:PO BOX 6212
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44101-1212
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6001 WOODLAND AVE
Practice Address - Street 2:SUITE 2345
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44104-2762
Practice Address - Country:US
Practice Address - Phone:216-426-9314
Practice Address - Fax:216-426-9314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002551213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSC0629063OtherMEDICAL INDIVIDUAL
OH0730276Medicaid
T97029Medicare UPIN
OHSC0629063OtherMEDICAL INDIVIDUAL
OH0730276Medicaid
OHDW9244231Medicare PIN