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NPI Code Detail

MEDICARE: SCOTT A. IRVINE DO

MEDICARE: SCOTT A. IRVINE DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207LP2900XPain Medicine (Anesthesiology) PhysicianL8741TX
2207L00000XAnesthesiology PhysicianL8741TX

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P01265608OTHERTXRR MEDICARE
3TXB165802OTHERTXMEDICARE PTAN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1730175035
Entity Type Code : Individual
Provider Name (Legal Business Name) : SCOTT A. IRVINE DO
Provider Business Mailing Address
First Line : PO BOX 11538
Second Line :
City : KILLEEN
State : TX
Zip : 76547-1538
Country : US
Telephone Number : 254-245-9175
Fax Number : 254-213-7771
Provider Business Practice Location Address
First Line : 3800 S W S YOUNG DR STE 201
Second Line :
City : KILLEEN
State : TX
Zip : 76542-3340
Country : US
Telephone Number : 254-245-9175
Fax Number : 254-213-7771
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2005
Last Update Date : 08/09/2022

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Directions to “ SCOTT A. IRVINE DO” Practice Location

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