Organization Active NPI

Scott W. Zimostrad, PH.D., P.C.

  • Clinical Neuropsychologist
  • Midland, MI
National Provider Identifier
1578738514
Registry record updated Apr 29, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
SZ630100 Issued in MI
Legal business name
SCOTT W. ZIMOSTRAD, PH.D., P.C.
Practice address
720 W Wackerly St
Suite 12
Midland, MI 48640-2769
Phone
(989) 839-6565
Fax
(989) 839-5794
NPI assigned
Apr 29, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2008

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

Authorized official

Name
Scott W Zimostrad, PH.D.
Title
Owner/Administrator
Phone
(989) 839-6565

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical NeuropsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103G00000X SZ630100 MI Primary

Addresses

Primary practice location

720 W Wackerly St
Suite 12
Midland, MI 48640-2769

Mailing address

720 W Wackerly St
Suite 12
Midland, MI 48640-2769
Phone (989) 839-6565

National Provider Directory

National Provider Directory

Locations

6957 W M 72 Hwy
Grayling, MI 49738
Phone (989) 839-6565

720 W Wackerly St
Ste 12
Midland, MI 48640
Phone (989) 839-6565

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1209427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209427200000",
    "number": "1578738514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 W WACKERLY ST",
            "address_2": "SUITE 12",
            "city": "MIDLAND",
            "state": "MI",
            "postal_code": "486402769",
            "telephone_number": "989-839-6565",
            "fax_number": "989-839-5794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 W WACKERLY ST",
            "address_2": "SUITE 12",
            "city": "MIDLAND",
            "state": "MI",
            "postal_code": "486402769",
            "telephone_number": "989-839-6565",
            "fax_number": "989-839-5794"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SCOTT W. ZIMOSTRAD, PH.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-29",
        "last_updated": "2008-04-29",
        "status": "A",
        "authorized_official_last_name": "ZIMOSTRAD",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER/ADMINISTRATOR",
        "authorized_official_telephone_number": "989-839-6565",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": "MI",
            "license": "SZ630100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Midland, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2008; 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.