Provider Demographics
NPI:1871573394
Name:SCRUGGS, MICHAEL COLEMAN (MD)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:COLEMAN
Last Name:SCRUGGS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:COLEMAN
Other - Last Name:SCRUGGS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 886
Mailing Address - Street 2:131 W 2ND ST
Mailing Address - City:RUTHERFORDTON
Mailing Address - State:NC
Mailing Address - Zip Code:28139
Mailing Address - Country:US
Mailing Address - Phone:828-287-2984
Mailing Address - Fax:828-287-3582
Practice Address - Street 1:288 S RIDGECREST AVE
Practice Address - Street 2:
Practice Address - City:RUTHERFORDTON
Practice Address - State:NC
Practice Address - Zip Code:28139
Practice Address - Country:US
Practice Address - Phone:828-286-5335
Practice Address - Fax:828-286-5231
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC202022085R0202X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7975083Medicaid
NC210273BMedicare ID - Type Unspecified
NC7975083Medicaid