MEDICARE: PHYSICIAN ASSISTANT SERVICES

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	363AS0400X	Surgical Physician Assistant

General Provider Information

NPI Number	:	1700888716
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICIAN ASSISTANT SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 27514
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85285-7514
Country	:	US
Telephone Number	:	480-967-6500
Fax Number	:	480-967-6540

Provider Business Practice Location Address
First Line	:	7804 S JENTILLY LN
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85284-1562
Country	:	US
Telephone Number	:	480-967-6500
Fax Number	:	480-967-6540

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. PAULA A STUFFLEBEAM
Credential	:	P.A.
Telephone Number	:	480-967-6500

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	10/29/2007

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Directions to “PHYSICIAN ASSISTANT SERVICES ” Practice Location

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