MEDICARE: JOHN WILLIAM SILVESTRI 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
2	363A00000X	Physician Assistant	PA.0003788	CO

General Provider Information

NPI Number	:	1679562987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN WILLIAM SILVESTRI PA-C

Provider Business Mailing Address
First Line	:	2695 ROCKY MOUNTAIN AVE
Second Line	:	STE 150
City	:	LOVELAND
State	:	CO
Zip	:	80538-9071
Country	:	US
Telephone Number	:	970-624-4036
Fax Number	:	970-490-4378

Provider Business Practice Location Address
First Line	:	1856 IRWIN DR BLDG 1058
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80913-4176
Country	:	US
Telephone Number	:	719-526-1910
Fax Number	:

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

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	07/28/2016

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