Provider Demographics
NPI:1932767019
Name:SCOTT, THOMAS ERNIE
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ERNIE
Last Name:SCOTT
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 1:12901 16TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-3736
Mailing Address - Country:US
Mailing Address - Phone:612-387-0042
Mailing Address - Fax:
Practice Address - Street 1:12901 16TH AVE S
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-3736
Practice Address - Country:US
Practice Address - Phone:612-387-0042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-03
Last Update Date:2022-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator