Provider Demographics
NPI:1750382578
Name:HOLLRAH, SCOTT A (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:A
Last Name:HOLLRAH
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 411039
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64141-1039
Mailing Address - Country:US
Mailing Address - Phone:913-234-1350
Mailing Address - Fax:
Practice Address - Street 1:12300 METCALF AVE
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-1324
Practice Address - Country:US
Practice Address - Phone:913-317-7485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-27556207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO206039703Medicaid
MO25060071OtherBCBS OF KC MO
KS100315800AMedicaid
KS01674018OtherBCBS KC MO GROUP 01674018
930066677OtherRR MEDICARE GROUP CG8899
P00216478OtherRR MEDICARE GROUP DC6712
KS100315800CMedicaid
KS25060051OtherBCBS KC MO
P00216478OtherRR MEDICARE GROUP DC6712
KSG71908Medicare UPIN
KS7638426Medicare PIN