Provider Demographics
NPI:1881600237
Name:SCOTT, JOHN W III (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:SCOTT
Suffix:III
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 1:679 E COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1049
Mailing Address - Country:US
Mailing Address - Phone:317-890-2000
Mailing Address - Fax:317-859-4269
Practice Address - Street 1:679 E COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1049
Practice Address - Country:US
Practice Address - Phone:317-859-7222
Practice Address - Fax:317-859-7220
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01036747A208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100068580Medicaid
IN000000091699OtherANTHEM PROVIDER NUMBER
IN000000091699OtherANTHEM PROVIDER NUMBER
IN100068580Medicaid
IN100194370OtherMEDICAID GROUP NUMBER
IN340012498OtherMEDICARE RAILROAD
IN340012509OtherMEDICARE RAILROAD
IN200288740OtherMEDICAID GROUP NUMBER
IN340012509OtherMEDICARE RAILROAD
IN1487680518OtherGROUP NPI NUMBER
IN100068580Medicaid
IN597870BMedicare PIN
IN345000BMedicare PIN