Provider Demographics
NPI:1174619241
Name:GREEN, SCOTT D (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:D
Last Name:GREEN
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 1:500 EAST DECATUR
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:NE
Mailing Address - Zip Code:68788-1566
Mailing Address - Country:US
Mailing Address - Phone:402-372-2477
Mailing Address - Fax:402-372-6770
Practice Address - Street 1:500 EAST DECATUR
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:NE
Practice Address - Zip Code:68788-1566
Practice Address - Country:US
Practice Address - Phone:402-372-2477
Practice Address - Fax:402-372-6770
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE17446207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NED07357OtherBCBS OF NEBRASKA
NE020051084OtherMEDICARE RAILROAD
NE0100484OtherUNITED HEALTH CARE
NE2873OtherMIDLANDS CHOICE
NE020051084OtherMEDICARE RAILROAD
NE2873OtherMIDLANDS CHOICE