Provider Demographics
NPI:1720499429
Name:WEBER, SCOTT (COTS)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:WEBER
Suffix:
Gender:M
Credentials:COTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 N SILVER ST
Mailing Address - Street 2:
Mailing Address - City:TRUTH OR CONSEQUENCES
Mailing Address - State:NM
Mailing Address - Zip Code:87901-1957
Mailing Address - Country:US
Mailing Address - Phone:575-894-1735
Mailing Address - Fax:
Practice Address - Street 1:1400 N SILVER ST
Practice Address - Street 2:
Practice Address - City:TRUTH OR CONSEQUENCES
Practice Address - State:NM
Practice Address - Zip Code:87901-1957
Practice Address - Country:US
Practice Address - Phone:575-894-1735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2851251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health