MEDICARE: DR. MICHAEL SHANE SCOTT D.O.

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
1	208000000X	Pediatrics Physician	17807	MS
2	207R00000X	Internal Medicine Physician	17807	MS

Other Identifiers

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

General Provider Information

NPI Number	:	1275535551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL SHANE SCOTT D.O.

Provider Business Mailing Address
First Line	:	118 FAIRFIELD DR
Second Line	:
City	:	NEW ALBANY
State	:	MS
Zip	:	38652-3107
Country	:	US
Telephone Number	:	662-534-0898
Fax Number	:	662-534-8905

Provider Business Practice Location Address
First Line	:	118 FAIRFIELD DR
Second Line	:
City	:	NEW ALBANY
State	:	MS
Zip	:	38652-3107
Country	:	US
Telephone Number	:	662-534-0898
Fax Number	:	662-534-8905

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	12/12/2025

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