Provider Demographics
NPI:1235125295
Name:POWELL, JAMES EDSON (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:EDSON
Last Name:POWELL
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 1:212 N PRAIRIE ST
Mailing Address - Street 2:
Mailing Address - City:FLANDREAU
Mailing Address - State:SD
Mailing Address - Zip Code:57028-1243
Mailing Address - Country:US
Mailing Address - Phone:605-997-2471
Mailing Address - Fax:605-997-2418
Practice Address - Street 1:212 N PRAIRIE ST
Practice Address - Street 2:
Practice Address - City:FLANDREAU
Practice Address - State:SD
Practice Address - Zip Code:57028-1243
Practice Address - Country:US
Practice Address - Phone:605-997-2471
Practice Address - Fax:605-997-2418
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD2098207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0139311Medicaid
IA13931OtherWELLMARK BC/BS
SD5613130Medicaid
IA080015869OtherRAILROAD MEDICARE
IA0139311Medicaid
IA080015869OtherRAILROAD MEDICARE
IA139311Medicare ID - Type Unspecified
SDS102587Medicare PIN
SDA01231Medicare UPIN