NPIMap

Organization Active NPI

Scott Pharmacy Inc

  • Community/Retail Pharmacy
  • Fayette, IA
National Provider Identifier
1669587473
Registry record updated Dec 12, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
556 Issued in IA
Legal business name
SCOTT PHARMACY INC
Practice address
238 S Main St
Fayette, IA 52142-9301
Phone
(563) 425-4530
Fax
(563) 425-4530
NPI assigned
Aug 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2018

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

Authorized official

Name
Jeffrey W Scott, RPH
Title
Owner/Pharmacist
Phone
(563) 425-4530

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
PharmacistGroup: 193400000X SINGLE SPECIALTY GROUP 183500000X 556 IA
Durable Medical Equipment & Medical Supplies 332B00000X 556 IA
Community/Retail Pharmacy 3336C0003X 556 IA Primary
Long Term Care Pharmacy 3336L0003X 556 IA

Addresses

Primary practice location

238 S Main St
Fayette, IA 52142-9301

Mailing address

PO Box 188
Fayette, IA 52142-0188
Phone (563) 425-4530

Other identifiers 1

IdentifierTypeStateIssuer
0479857MedicaidIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930082079 IA DME Supplier - PharmacyDME Supplier - Medical Supply Company With Registered Pharmacist 3678780368 Practice locations: Fayette, IA
O20191203000699 IA Part B Supplier - Mass Immunization (Roster Biller Only) 3678780368 Practice locations: Fayette, IA

National Provider Directory

National Provider Directory
Tax ID family
Scott Pharmacy Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 3

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": "1156032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1544572800000",
    "number": "1669587473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 188",
            "city": "FAYETTE",
            "state": "IA",
            "postal_code": "521420188",
            "telephone_number": "563-425-4530",
            "fax_number": "563-425-4530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "238 S MAIN ST",
            "city": "FAYETTE",
            "state": "IA",
            "postal_code": "521429301",
            "telephone_number": "563-425-4530",
            "fax_number": "563-425-4530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SCOTT PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-20",
        "last_updated": "2018-12-12",
        "status": "A",
        "authorized_official_last_name": "SCOTT",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER/PHARMACIST",
        "authorized_official_telephone_number": "563-425-4530",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pharmacist",
            "state": "IA",
            "license": "556",
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "IA",
            "license": "556",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IA",
            "license": "556",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "IA",
            "license": "556",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0479857",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayette, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.