Provider Demographics
NPI:1861938433
Name:SCOTT EDWARD BOWLIN
Entity type:Organization
Organization Name:SCOTT EDWARD BOWLIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:816-321-2543
Mailing Address - Street 1:5440 CLARE RD
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66226-2811
Mailing Address - Country:US
Mailing Address - Phone:816-321-2543
Mailing Address - Fax:816-873-1121
Practice Address - Street 1:1515 W WHITE OAK ST
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64050-2557
Practice Address - Country:US
Practice Address - Phone:816-321-2543
Practice Address - Fax:816-873-1121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5P18207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO080069169OtherRAILROAD MEDICARE TRAVELERS
MO39049OtherCOVENTRY/ADVANTRA
5053741OtherCIGNA
11078057OtherBLUE CROSS & BLUE SHIELD OF KANSAS CITY
MO39049OtherCOVENTRY/ADVANTRA