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NPI Code Detail

MEDICARE: JOHNATHAN SIVILAY PA-C

MEDICARE: JOHNATHAN SIVILAY 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
1363A00000XPhysician Assistant19088CA
2363A00000XPhysician Assistant

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1229328OTHERCASTATE OF WASHINGTON
219088OTHERCALICENSE

General Provider Information

NPI Number : 1568658359
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHNATHAN SIVILAY PA-C
Provider Business Mailing Address
First Line : 7550 W VILLAGE CIR STE 1
Second Line :
City : WICHITA
State : KS
Zip : 67205-9364
Country : US
Telephone Number : 316-838-2020
Fax Number : 316-838-7574
Provider Business Practice Location Address
First Line : 7550 W VILLAGE CIR STE 1
Second Line :
City : WICHITA
State : KS
Zip : 67205-9364
Country : US
Telephone Number : 316-838-2020
Fax Number : 316-838-7574
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2007
Last Update Date : 03/22/2018

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Directions to “ JOHNATHAN SIVILAY PA-C” Practice Location

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