SCOTT WONG (NPI# 1275604498) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275604498 |
| Entity Type | Individual |
| Full Name | SCOTT WONG |
| Credential | MD |
| Practice Address |
6810 State Route 162 Ste 105 Maryville IL 62062-8501 |
| Mailing Address |
1836 Lackland Hill Pkwy Credentialing Department Saint Louis MO 63146-3572 |
| Practice Telephone | 6182885711 |
| Mailing Telephone | 3149890300 |
| Mailing Fax Number | 3148101399 |
| Enumeration Date | 2006-11-10 |
| Last Update Date | 2008-02-19 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2086S0129X |
Surgery Specialization: Vascular Surgery |
IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 036103837002 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861531428 | Scott Kendrick Wong | Dentist | 848 S Beretania St Ste 304, Honolulu, HI 96813-2551 | 2007-02-06 |
| 1528529526 | Scott Wong | Student in an Organized Health Care Education/Training Program | 751 S Bascom Ave, San Jose, CA 95128-2604 | 2019-03-31 |
| 1356682280 | Scott M Wong | Registered Nurse | 1959 Ne Pacific St, Seattle, WA 98195-0001 | 2013-03-01 |
| 1750641155 | Scott Wong | Student in an Organized Health Care Education/Training Program | 1215 Lee St, Box 800170, Charlottesville, VA 22908-2312 | 2012-05-21 |
| 1699033209 | Scott Jeffrey Wong | Pharmacist | 975 Sereno Dr, Vallejo, CA 94589-2441 | 2012-05-02 |
| Street Address |
6810 STATE ROUTE 162 STE 105 |
| City | MARYVILLE |
| State | IL |
| Zip Code | 62062-8501 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922009943 | Mark Stephen Fedder | Internal Medicine | 6810 State Route 162, Suite 211, Maryville, IL 62062-8501 | 2005-08-02 |
| 1003295213 | Msa Alliance, LLC Dba-southern Illinois Vascular and Vein Surgery | Surgery | 6810 State Route 162, Suite 100, Maryville, IL 62062 | 2015-05-20 |
| 1467867234 | Premier Foot and Ankle of Illinois, PC | Podiatrist | 6810 State Route 162, Suite 20, Maryville, IL 62062-8587 | 2014-06-30 |
| 1043521719 | Gabriel Cardenas Jr. | Podiatrist | 6810 State Route 162, Suite 20, Maryville, IL 62062-8587 | 2010-06-28 |
| 1780818831 | Patricia Renee Verdu | Registered Nurse | 6810 State Route 162, Maryville, IL 62062-8501 | 2009-05-04 |
| 1518143254 | James J. Dalla Riva, Md, PC | Specialist | 6810 State Route 162, Suite 301, Maryville, IL 62062-8501 | 2008-01-11 |
| 1184806101 | Mark Fedder, Md, PC | Internal Medicine | 6810 State Route 162, Suite 211, Maryville, IL 62062-8501 | 2007-11-30 |
| 1518178730 | Melissa Ann Kershaw | Internal Medicine | 6810 State Route 162, Ste 102, Maryville, IL 62062-8501 | 2007-05-28 |
| 1710009840 | James W. Lane | Psychologist | 6810 State Route 162, Suite 215, Maryville, IL 62062-8501 | 2007-04-06 |
| 1245373489 | Fairview Heights Medical Group Sc | Internal Medicine | 6810 State Route 162, Suite 203, Maryville, IL 62062-8501 | 2007-02-15 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104325091 | Jennifer M Oyler | Physician Assistant | 6812 State Route 162 Suite 120, Maryville, IL 62062 | 2018-02-06 |
| 1710495965 | Sarah Elizabeth Barto | Family Medicine | 2133 Vadalabene Drive, Suite Sb, Maryville, IL 62062 | 2018-01-22 |
| 1104348085 | Lindsey Nicole Langendorf | Chiropractor | 62 Executive Plaza Ct, Maryville, IL 62062 | 2017-07-12 |
| 1043750540 | Gina Saal | Nurse Anesthetist, Certified Registered | 6800 Rt 162, Maryville, IL 62062 | 2017-03-02 |
| 1548657737 | Karen Michelle Bertels | Emergency Medicine | 6800 Il - 162, Maryville, IL 62062 | 2015-04-25 |
| 1811258148 | Debra Ann Hoelscher | Internal Medicine | 2102 Vadalabene, Maryville, IL 62062 | 2012-06-04 |
| 1538438445 | Casey Elizabeth Wiesemeyer | Speech-Language Pathologist | 2201 Copper Creek Rd, Maryville, IL 62062 | 2011-12-21 |
| 1407144819 | Norah Claire Farley Baker | Family Medicine | 10 Professional Park Dr., Maryville, IL 62062 | 2011-07-19 |
| 1891092474 | Kimberly M Schneider | Physician Assistant | 20b Professional Park Drive, Maryville, IL 62062 | 2011-02-17 |
| 1669782397 | Purandhri Patel | Physical Therapist | 6820 State Route 162, Maryville, IL 62062 | 2010-10-15 |
| Find all providers in zip 62062 | ||||
| Taxonomy Code | 2086S0129X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Vascular Surgery |
| A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801339965 | Msa Alliance, LLC | Surgery | 2016 Vadalabene Dr, Suite B, Maryville, IL 62062-6901 | 2016-11-22 |
| 1003295213 | Msa Alliance, LLC Dba-southern Illinois Vascular and Vein Surgery | Surgery | 6810 State Route 162, Suite 100, Maryville, IL 62062 | 2015-05-20 |
| 1053711895 | Msa Alliance, LLC | Surgery | 2133 Vadalabene Dr, Suite 2, Maryville, IL 62062-5839 | 2014-08-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396267324 | Congress Vascular Center LLC | Surgery | 41 W Congress Pkwy Fl 1, Chicago, IL 60605-1531 | 2017-07-11 |
| 1043731300 | Elmwood Park Vascular Center LLC | Surgery | 7230 W North Ave Ste 108, Elmwood Park, IL 60707-4261 | 2017-06-27 |
| 1588105811 | Mickey Graphia | Surgery | 701 N 1st St # D346, Springfield, IL 62702 | 2017-03-20 |
| 1992126668 | Vascular Specialists LLC | Surgery | 20060 Governors Dr Ste 102, Olympia Fields, IL 60461-1099 | 2013-12-26 |
| 1588959548 | Patrick Michael Sullivan Neville | Surgery | 4600 Memorial Dr Ste 120, Belleville, IL 62226-5359 | 2011-06-17 |
| 1235454968 | Margaret Claire Rigamer | Surgery | 1901 W Harrison St Dept Of, Chicago, IL 60612-3714 | 2010-04-06 |
| 1215251541 | John V. White, Md, LLC | Surgery | 8816 W Dempster St, Niles, IL 60714-5109 | 2010-03-15 |
| 1710212733 | Vascular Surgery and Interpretation S.c. | Surgery | 3330 W 177th St Ste 2c1, Hazel Crest, IL 60429-2184 | 2009-10-08 |
| 1538391792 | Usa Vein Clinics of Chicago LLC | Surgery | 4141 Dundee Rd, Northbrook, IL 60062-2129 | 2009-08-20 |
| 1306010731 | Tanq, Inc. | Surgery | 18510 S Marilynn Ct, Mokena, IL 60448-9517 | 2008-04-16 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.