MEDICARE: DR. BENJAMIN SCOTT WILSON MD

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	207X00000X	Orthopaedic Surgery Physician	N1956	TX

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699978486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BENJAMIN SCOTT WILSON MD

Provider Business Mailing Address
First Line	:	501 AIR PARK AVE
Second Line	:
City	:	GREENVILLE
State	:	TX
Zip	:	75402-3000
Country	:	US
Telephone Number	:	903-408-5834
Fax Number	:	903-408-1129

Provider Business Practice Location Address
First Line	:	5101 WELLINGTON ST UNIT A
Second Line	:
City	:	GREENVILLE
State	:	TX
Zip	:	75402-6040
Country	:	US
Telephone Number	:	903-408-7768
Fax Number	:	903-408-7769

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

Provider Enumeration Date	:	06/08/2007
Last Update Date	:	07/31/2025

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