Provider Demographics
NPI:1194733451
Name:WILSON, SCOTT (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:WILSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8055 O ST
Mailing Address - Street 2:STE 300
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2580
Mailing Address - Country:US
Mailing Address - Phone:402-421-0896
Mailing Address - Fax:402-421-0945
Practice Address - Street 1:4501 S 70TH ST
Practice Address - Street 2:STE 130
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-4282
Practice Address - Country:US
Practice Address - Phone:402-484-5100
Practice Address - Fax:402-484-5151
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE21493207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE01-03335OtherUHC
NE470780857 12Medicaid
NE24376OtherMIDLAND'S CHOICE
NE00286OtherBCBS
275525Medicare PIN
NE470780857 12Medicaid