Scott Pettis

Primary specialty

Customized Equipment (DME)Taxonomy code 332BC3200X

License

ATP 60119 Issued in TX

Practice address

5324 Davis Blvd
North Richland Hills, TX 76180-6824

Phone

(817) 282-5273

NPI assigned

Jan 8, 2016

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Home Medical Equipment of Fort Worth, LLC.

  • Customized Equipment (DME)
  • North Richland Hills, TX
  • NPI 1063597284

  Durable Medical Equipment & Medical Supplies

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1452211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1452211200000",
    "number": "1174989982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5324 DAVIS BLVD",
            "city": "NORTH RICHLAND HILLS",
            "state": "TX",
            "postal_code": "761806824",
            "telephone_number": "817-282-5273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5324 DAVIS BLVD",
            "city": "NORTH RICHLAND HILLS",
            "state": "TX",
            "postal_code": "761806824",
            "telephone_number": "817-282-5273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTIS",
        "first_name": "SCOTT",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-01-08",
        "last_updated": "2016-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "TX",
            "license": "ATP 60119",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chase Pemberton, DPT
• Heather Penka, MPH, ATC, LAT
• Makenzie Peppers, APRN
• Colby Ray Perez
• Stephen J Perez
• Lily Pham-Smith, PHARM. D
• Andy Pham, PHARM.D
• Stephanie Pham, PT, DPT
• Ross Phan, PHARMD, BCPS
• Jeffrey B Phelps, M.D.

• Customized Equipment (DME) in North Richland Hills, TX
• Providers in North Richland Hills, TX by specialty
• Customized Equipment (DME) in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.