Provider Demographics
NPI:1144723636
Name:ROBERTS, SCOTT K
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:K
Last Name:ROBERTS
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 1:2650 HOLSTON RIVER DR
Mailing Address - Street 2:
Mailing Address - City:RUTLEDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37861-4330
Mailing Address - Country:US
Mailing Address - Phone:865-828-6450
Mailing Address - Fax:865-828-6450
Practice Address - Street 1:2650 HOLSTON RIVER DR
Practice Address - Street 2:
Practice Address - City:RUTLEDGE
Practice Address - State:TN
Practice Address - Zip Code:37861-4330
Practice Address - Country:US
Practice Address - Phone:865-828-6450
Practice Address - Fax:865-828-6450
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-12
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN045038696343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)