MEDICARE: EDWARD JAMES POWELL PA-C

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	363A00000X	Physician Assistant	1252	AZ

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
2	03D09444436	OTHER	AZ	CLIA

General Provider Information

NPI Number	:	1588734750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD JAMES POWELL PA-C

Provider Business Mailing Address
First Line	:	171 W CENTRAL AVE
Second Line	:
City	:	COOLIDGE
State	:	AZ
Zip	:	85228-4405
Country	:	US
Telephone Number	:	520-723-7726
Fax Number	:	520-723-4513

Provider Business Practice Location Address
First Line	:	171 W CENTRAL AVE
Second Line	:
City	:	COOLIDGE
State	:	AZ
Zip	:	85228-4405
Country	:	US
Telephone Number	:	520-723-7726
Fax Number	:	520-723-4513

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

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	03/07/2023

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