Basic Information
Provider Information
NPI: 1255968350
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: AMRHEIN
FirstName: SCOTT
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2836 YONKERS CT
Address2:  
City: OVIEDO
State: FL
PostalCode: 327658412
CountryCode: US
TelephoneNumber: 3219478852
FaxNumber:  
Practice Location
Address1: 1 MEDICAL CENTER BLVD 7TH FLOOR
Address2:  
City: WINSTON SALEM
State: NC
PostalCode: 271570001
CountryCode: US
TelephoneNumber: 3367162011
FaxNumber: 3367165168
Other Information
ProviderEnumerationDate: 03/26/2020
LastUpdateDate: 03/26/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/26/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  Y Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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