MEDICARE: JACOB MCAVOY DMSC, PA-C

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	PA.PA.70003991	WA
2	363A00000X	Physician Assistant	PA195490	OR

General Provider Information

NPI Number	:	1154975001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB MCAVOY DMSC, PA-C

Provider Business Mailing Address
First Line	:	8444 N 90TH ST STE 100
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85258-4437
Country	:	US
Telephone Number	:	602-248-8886
Fax Number	:	602-854-0504

Provider Business Practice Location Address
First Line	:	651 W 7TH AVE STE 655
Second Line	:
City	:	EUGENE
State	:	OR
Zip	:	97402-5113
Country	:	US
Telephone Number	:	458-320-0320
Fax Number	:

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

Provider Enumeration Date	:	07/30/2019
Last Update Date	:	04/13/2026

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