MEDICARE: SCOTT J. POWELL M.D.

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	208600000X	Surgery Physician	L8897	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00282718	OTHER	TX	RAILROAD MEDICARE

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
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	8S6184	OTHER	TX	BLUE CROSS

General Provider Information

NPI Number	:	1285637082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT J. POWELL M.D.

Provider Business Mailing Address
First Line	:	PO BOX 9477
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75711-9477
Country	:	US
Telephone Number	:	903-594-2450
Fax Number	:	903-594-2450

Provider Business Practice Location Address
First Line	:	1725 S INTERSTATE 35 E STE 101
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76205-6603
Country	:	US
Telephone Number	:	940-808-0949
Fax Number	:	903-438-2197

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	07/28/2022

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Directions to “ SCOTT J. POWELL M.D.” Practice Location

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