Basic Information
| Provider Information | |||||||||
| NPI: | 1356663561 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SCOTT M JACOBSON DO PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 W OTTERMAN ST | ||||||||
| Address2: | SUITE B | ||||||||
| City: | GREENSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 156012126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7248506946 | ||||||||
| FaxNumber: | 7248366825 | ||||||||
| Practice Location | |||||||||
| Address1: | 532 W PITTSBURGH ST | ||||||||
| Address2: | |||||||||
| City: | GREENSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 156012239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7248324000 | ||||||||
| FaxNumber: | 7248366825 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2010 | ||||||||
| LastUpdateDate: | 02/16/2010 | ||||||||
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| AuthorizedOfficialLastName: | JACOBSON | ||||||||
| AuthorizedOfficialFirstName: | SCOTT | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7248506945 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.