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1932156692

NPI Code Detail

MEDICARE: WALTER SCOTT EDWARDS MEDLIN M.D.

MEDICARE: WALTER SCOTT EDWARDS MEDLIN 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	47825-020	WI
2	208600000X	Surgery Physician	MD00037282	WA
3	208600000X	Surgery Physician	12854	MT
4	208600000X	Surgery Physician	8984752-1205	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7762232	OTHER	WA	AETNA
2	0248634	OTHER	WA	L&I AND CRIME VICTIMS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	1008ME	OTHER	WA	REGENCE

General Provider Information

NPI Number	:	1932156692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WALTER SCOTT EDWARDS MEDLIN M.D.

Provider Business Mailing Address
First Line	:	1046 E 100 S
Second Line	:	SUITE A
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-1520
Country	:	US
Telephone Number	:	406-694-2487
Fax Number	:	801-746-2886

Provider Business Practice Location Address
First Line	:	1046 E 100 S
Second Line	:	SUITE A
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-1520
Country	:	US
Telephone Number	:	406-694-2487
Fax Number	:	801-746-2886

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

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	08/21/2014

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Directions to “ WALTER SCOTT EDWARDS MEDLIN M.D.” Practice Location

Language	Start Address	Practice Location

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