MEDICARE: MARY VIOLA RANKIN PA

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	363A00000X	Physician Assistant	433	WV

General Provider Information

NPI Number	:	1114023579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY VIOLA RANKIN PA

Provider Business Mailing Address
First Line	:	200 CORPORATE BLVD
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-3870
Country	:	US
Telephone Number	:	800-893-9698
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 MEDICAL PARK
Second Line	:	WHEELING HOSPITAL INC
City	:	WHEELING
State	:	WV
Zip	:	26003-6379
Country	:	US
Telephone Number	:	304-243-3124
Fax Number	:

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

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	09/19/2022

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