Provider Demographics
NPI:1235312737
Name:SCOTT C. CLAYCOMB, M.D., P.A.
Entity type:Organization
Organization Name:SCOTT C. CLAYCOMB, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:C
Authorized Official - Last Name:CLAYCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-367-8534
Mailing Address - Street 1:PO BOX 890
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:AR
Mailing Address - Zip Code:71671-0890
Mailing Address - Country:US
Mailing Address - Phone:870-367-8534
Mailing Address - Fax:870-367-0264
Practice Address - Street 1:301 HIGHWAY 425 S
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:AR
Practice Address - Zip Code:71655-4611
Practice Address - Country:US
Practice Address - Phone:870-367-8534
Practice Address - Fax:870-367-0264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC7907207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR180024861OtherRAILROAD MEDICARE
AR54339OtherAR BCBS
AR128298002Medicaid
AR16703OtherQUALCHOICE
AR128298002Medicaid
AR54339Medicare PIN