MEDICARE: TAMI C RUNYAN 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
1	363A00000X	Physician Assistant	0010-00421	NC

General Provider Information

NPI Number	:	1851351787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMI C RUNYAN PA

Provider Business Mailing Address
First Line	:	2707 MEDICAL OFFICE PL
Second Line	:
City	:	GOLDSBORO
State	:	NC
Zip	:	27534-9458
Country	:	US
Telephone Number	:	919-735-9146
Fax Number	:	919-735-0582

Provider Business Practice Location Address
First Line	:	2707 MEDICAL OFFICE PL
Second Line	:
City	:	GOLDSBORO
State	:	NC
Zip	:	27534-9458
Country	:	US
Telephone Number	:	919-735-9146
Fax Number	:	919-735-0582

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

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	06/03/2010

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Directions to “ TAMI C RUNYAN PA” Practice Location

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