Provider Demographics
NPI:1740406719
Name:DR. SCOTT COMPTON D.O.
Entity type:Organization
Organization Name:DR. SCOTT COMPTON D.O.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:LAURIE
Authorized Official - Last Name:COMPTON
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:417-667-4620
Mailing Address - Street 1:127 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEVADA
Mailing Address - State:MO
Mailing Address - Zip Code:64772-3363
Mailing Address - Country:US
Mailing Address - Phone:417-667-4620
Mailing Address - Fax:417-667-4650
Practice Address - Street 1:127 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NEVADA
Practice Address - State:MO
Practice Address - Zip Code:64772-3363
Practice Address - Country:US
Practice Address - Phone:417-667-4620
Practice Address - Fax:417-667-4650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR1J25207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO243863719Medicaid
MO243863719Medicaid
MO0000172Medicare ID - Type Unspecified