MEDICARE: TERI JEAN SCHROCK PAC

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	PA441	ME

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	:	1760478382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERI JEAN SCHROCK PAC

Provider Business Mailing Address
First Line	:	12 HIGH ST
Second Line	:	STE. 301
City	:	LEWISTON
State	:	ME
Zip	:	04240-7676
Country	:	US
Telephone Number	:	207-795-5730
Fax Number	:	207-795-5749

Provider Business Practice Location Address
First Line	:	12 HIGH ST
Second Line	:	STE. 301
City	:	LEWISTON
State	:	ME
Zip	:	04240-7676
Country	:	US
Telephone Number	:	207-795-5730
Fax Number	:	207-795-5749

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

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	09/17/2012

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Directions to “ TERI JEAN SCHROCK PAC” Practice Location

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