Provider Demographics
NPI:1487813580
Name:SCOTT MEDINVESTMENT GROUP, LLC
Entity type:Organization
Organization Name:SCOTT MEDINVESTMENT GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CLINTON
Authorized Official - Middle Name:HERWIN
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:609-440-8714
Mailing Address - Street 1:3903 PORTAGE RD
Mailing Address - Street 2:SUITE C #161
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46628-6191
Mailing Address - Country:US
Mailing Address - Phone:609-440-8714
Mailing Address - Fax:
Practice Address - Street 1:3903 PORTAGE RD
Practice Address - Street 2:SUITE C #161
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46628-6191
Practice Address - Country:US
Practice Address - Phone:609-440-8714
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-03
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000990A213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty