MEDICARE: S SCOTT OLEXY 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	PA9103313	FL
2	363AS0400X	Surgical Physician Assistant	0110002649	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235101536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	S SCOTT OLEXY PA-C

Provider Business Mailing Address
First Line	:	1636 REGULUS AVE
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23461-2200
Country	:	US
Telephone Number	:	757-893-2015
Fax Number	:

Provider Business Practice Location Address
First Line	:	1636 REGULUS AVE
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23461-2200
Country	:	US
Telephone Number	:	757-893-2015
Fax Number	:

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

Provider Enumeration Date	:	02/02/2006
Last Update Date	:	03/11/2009

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