Provider Demographics
NPI:1255735973
Name:BABCOCK, SCOTT WILLIAM
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:WILLIAM
Last Name:BABCOCK
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 1:841 BONNIE SCOTLAND DR
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE GROVE
Mailing Address - State:AR
Mailing Address - Zip Code:72753-5001
Mailing Address - Country:US
Mailing Address - Phone:316-300-0109
Mailing Address - Fax:
Practice Address - Street 1:603 N PROGRESS AVE
Practice Address - Street 2:
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761-4352
Practice Address - Country:US
Practice Address - Phone:316-300-0109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC003178367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200726500AMedicaid
AR218819001Medicaid