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Scott Edward Withers

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

9900 Bren Rd E, Minnetonka, MN 55343-9664

PECOS Enrollment

This provider is enrolled in PECOS as SCOTT WITHERS.

Based on the most recent information from CMS, provider Scott Edward Withers is legally eligible to order and refer claims for DME and PMD services only.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 11:47 AM.

Profile Details

Provider ID
1417991423
Provider Type
Individual
Full Name
Withers, Scott Edward
Credential
NP

Gender
Male
Sole Proprietor
No
Enumeration Date
6/16/2006
Last Updated
9/14/2020

Contact Information

Practice Location

9900 Bren Rd E, Minnetonka, MN 55343-9664

(972) 310-7339

Unlisted Fax

Mailing Location

102 Kelvington Dr, Anna, TX 75409-0056

(972) 310-7339

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363L00000X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License 648384 Texas
Code 363LF0000X	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License AP110973 Texas

Provider Identifiers

ID	Description	Issuer
ID 00X940	Description Other	Issuer MEDICARE GROUP PTAN Texas

Scott Edward Withers

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Schaefer, Dawn M

Capron, Scott A

Schultz, Jane M

Newkirk, Chloe D.

Cobb, Joel C

Atkinson, Alysia

Mcclintic, Kimberly Anne

Serdynski, Georgetta S

Lukas, Henny

Sullivan, Elizabeth Mary