DR. SCOTT A HATHAWAY (NPI# 1669563763) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669563763 |
| Entity Type | Individual |
| Full Name | DR. SCOTT A HATHAWAY |
| Credential | D.O. |
| Practice Address |
309 N Bartlett St Shawano WI 54166-2127 |
| Practice Telephone | 7155262111 |
| Practice Fax Number | 7155269174 |
| Mailing Telephone | 7155262111 |
| Mailing Fax Number | 7155269174 |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2012-11-02 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207PE0004X |
Emergency Medicine Specialization: Emergency Medical Services |
36307 | WI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 30064500 | 05 |
| Street Address |
309 N BARTLETT ST |
| City | SHAWANO |
| State | WI |
| Zip Code | 54166-2127 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609877505 | Robert R Eastman | Family Medicine | 309 N Bartlett St, Shawano, WI 54166-2127 | 2005-08-02 |
| 1336525526 | Elle Kosciuk | Specialist/Technologist | 309 N Bartlett St, Shawano, WI 54166-2127 | 2015-08-11 |
| 1952684607 | Sharisa M Ruh | Physician Assistant | 309 N Bartlett St, Shawano, WI 54166-2127 | 2011-09-20 |
| 1508155474 | Forefront Dermatology, S.c. | Dermatology | 309 N Bartlett St, Shawano, WI 54166 | 2011-03-31 |
| 1265731590 | Paul Michael Theuerkauf | Physical Therapist | 309 N Bartlett St, Shawano, WI 54166-2127 | 2011-03-25 |
| 1942430996 | Sheila M Landon | Nurse Practitioner | 309 N Bartlett St, Shawano, WI 54166-2127 | 2009-07-23 |
| 1639279383 | Rajeshwar Hanmiah | Emergency Medicine | 309 N Bartlett St, Shawano, WI 54166-2127 | 2006-09-23 |
| 1598863334 | George E Vidalakis | Emergency Medicine | 309 N Bartlett St, Shawano, WI 54166-2127 | 2006-09-20 |
| 1780670034 | Tony O Sandstrom | Anesthesiology | 309 N Bartlett St, Shawano, WI 54166-2127 | 2005-09-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134641848 | Nicole Jeannine Klotzbuecher | Optometrist | 150 County Road B, Shawano, WI 54166 | 2017-07-13 |
| 1437605714 | Jennifer Marie Franke | Counselor | 504 Lakeland St, Shawano, WI 54166 | 2016-08-28 |
| 1699017913 | Benjamin D Schlais | Family Medicine | 100 County Hwy B, Shawano, WI 54166 | 2013-03-25 |
| 1154574366 | Luke T Johnson | Speech-Language Pathologist | N3684 River Road, Shawano, WI 54166 | 2008-10-31 |
| 1902054315 | Robert Joseph Bohr Jr. | Physical Therapy Assistant | N6590 Fox Lane, Shawano, WI 54166 | 2008-08-28 |
| 1790945863 | Patricia Rae Ainsworth | Physical Therapist | 1436 South Lincoln Street, Shawano, WI 54166 | 2008-06-12 |
| 1649491820 | Shawano-gresham School District | Local Education Agency (LEA) | 1050 South Union Street, Shawano, WI 54166 | 2007-05-02 |
| 1114043387 | Thomas G Peterson | Optometrist | 150a County Road B, Shawano, WI 54166 | 2007-03-21 |
| 1740343086 | John Milton Dovorany | Dentist | 1488 E Green Bay St, Shawano, WI 54166 | 2006-12-18 |
| 1265526305 | Charles E Lamarche | Counselor | 420 E Green Bay St, Ste 201, Shawano, WI 54166 | 2006-10-03 |
| Find all providers in zip 54166 | ||||
| Taxonomy Code | 207PE0004X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| Specialization | Emergency Medical Services |
| An emergency medicine physician who specializes in non-hospital based emergency medical services (e.g., disaster site, accident scene, transport vehicle, etc.) to provide pre-hospital assessment, treatment, and transport patients. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A Certification of Added Qualifications (CAQ) is issued by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639279383 | Rajeshwar Hanmiah | Emergency Medicine | 309 N Bartlett St, Shawano, WI 54166-2127 | 2006-09-23 |
| 1598863334 | George E Vidalakis | Emergency Medicine | 309 N Bartlett St, Shawano, WI 54166-2127 | 2006-09-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144703653 | Quinton Jarrett Peters | Emergency Medicine | 1204 S Jefferson St, Appleton, WI 54915-1726 | 2018-09-11 |
| 1497792139 | John A Culp | Emergency Medicine | 1446 N Randall Ave, Janesville, WI 53545-1122 | 2006-06-01 |
| 1861440505 | Alice C Bustos | Emergency Medicine | 7220 W National Ave, West Allis, WI 53214-4734 | 2006-05-05 |
| 1184690133 | Manuel A. Rivera | Emergency Medicine | 5000 Memorial Dr, Two Rivers, WI 54241-3900 | 2006-02-28 |
| 1942588132 | Watertown Regional Medical Center, Inc | Emergency Medicine | 125 Hospital Dr, Watertown, WI 53098-3303 | 2011-07-22 |
| 1366692287 | James John Macneal | Emergency Medicine | 1000 Mineral Point Ave, Janesville, WI 53548-2940 | 2008-09-28 |
| 1770646721 | Larry R Brunzlick | Emergency Medicine | 135 South Gibson Street, Medford, WI 54451 | 2006-12-19 |
| 1548378367 | John Malcolm Mckichan | Emergency Medicine | 11040 N State Road 77, Hayward, WI 54843-6391 | 2006-08-29 |
| 1669407649 | Mohammad Dodwad | Emergency Medicine | 900 College Ave W, Ladysmith, WI 54848-2116 | 2006-07-11 |
| 1023047859 | Richard Mayrer | Emergency Medicine | 2251 N Shore Dr, Rhinelander, WI 54501-8360 | 2006-07-02 |
| 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.