Provider Demographics
NPI:1285067389
Name:POWELL AND FUSELIER MEDICAL, PLLC
Entity type:Organization
Organization Name:POWELL AND FUSELIER MEDICAL, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:J
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-278-0140
Mailing Address - Street 1:1614 SCRIPTURE ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-3837
Mailing Address - Country:US
Mailing Address - Phone:225-278-0140
Mailing Address - Fax:866-335-0887
Practice Address - Street 1:1614 SCRIPTURE ST
Practice Address - Street 2:SUITE 3
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-3837
Practice Address - Country:US
Practice Address - Phone:225-278-0140
Practice Address - Fax:866-335-0887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8897208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty