Provider Demographics
NPI:1740280718
Name:SCOTT, KEITH A (MD)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:A
Last Name:SCOTT
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:PO BOX 968
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29620-0968
Mailing Address - Country:US
Mailing Address - Phone:864-366-9681
Mailing Address - Fax:864-366-5600
Practice Address - Street 1:901 W GREENWOOD ST
Practice Address - Street 2:SUITE 9
Practice Address - City:ABBEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29620-5717
Practice Address - Country:US
Practice Address - Phone:864-366-9681
Practice Address - Fax:864-366-5600
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21174207Q00000X
AL23717207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCRHC210Medicaid
SC21174OtherSC LICENSE NUMBER
H00020Medicare UPIN
SC423971Medicare PIN
SCH00020Medicare UPIN
SCRHC210Medicaid
AL1750393682Medicaid
AL529700760Medicaid
AL541392604Medicaid