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NPI Code Detail

MEDICARE: ELIZABETH YARTZ PA

MEDICARE: ELIZABETH YARTZ PA
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 Assistant9061MN
2363AM0700XMedical Physician Assistant9061MN

Other Identifiers

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

General Provider Information

NPI Number : 1750352092
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH YARTZ PA
Provider Business Mailing Address
First Line : 1300 ANNE ST NW
Second Line :
City : BEMIDJI
State : MN
Zip : 56601-5103
Country : US
Telephone Number : 218-333-5000
Fax Number :
Provider Business Practice Location Address
First Line : 1300 ANNE ST NW
Second Line :
City : BEMIDJI
State : MN
Zip : 56601-5103
Country : US
Telephone Number : 218-333-5000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/26/2006
Last Update Date : 08/05/2013

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Directions to “ ELIZABETH YARTZ PA” Practice Location

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