MEDICARE: MRS. RACHEL MARIE SARGENT 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	085003056	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CF3444	OTHER	IL	MEDICARE RR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	208554	OTHER	IL	HEALTH ALLIANCE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164618633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RACHEL MARIE SARGENT PA-C

Provider Business Mailing Address
First Line	:	600 N. GIANT CITY RD
Second Line	:
City	:	CARBONDALE
State	:	IL
Zip	:	62902-6413
Country	:	US
Telephone Number	:	618-549-2500
Fax Number	:	618-549-2525

Provider Business Practice Location Address
First Line	:	600 N. GIANT CITY RD
Second Line	:
City	:	CARBONDALE
State	:	IL
Zip	:	62902-6413
Country	:	US
Telephone Number	:	618-549-2500
Fax Number	:	618-549-2525

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

Provider Enumeration Date	:	09/19/2007
Last Update Date	:	11/06/2014

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