Provider Demographics
NPI:1912606286
Name:SCAGGS, RONNIE DAN
Entity Type:Individual
Prefix:
First Name:RONNIE
Middle Name:DAN
Last Name:SCAGGS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3049 E PITCHIN RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45502-9331
Mailing Address - Country:US
Mailing Address - Phone:937-206-7463
Mailing Address - Fax:937-265-1040
Practice Address - Street 1:3049 E PITCHIN RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45502-9331
Practice Address - Country:US
Practice Address - Phone:937-206-7463
Practice Address - Fax:937-265-1040
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker