MEDICARE: PAUL R. NILES 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	363AM0700X	Medical Physician Assistant	001878	IA

General Provider Information

NPI Number	:	1932384971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL R. NILES PA-C

Provider Business Mailing Address
First Line	:	PO BOX 328
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51102-0328
Country	:	US
Telephone Number	:	712-279-5830
Fax Number	:	712-279-5843

Provider Business Practice Location Address
First Line	:	321 MILL ST
Second Line	:
City	:	AKRON
State	:	IA
Zip	:	51001-7712
Country	:	US
Telephone Number	:	712-568-2411
Fax Number	:	712-568-2849

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

Provider Enumeration Date	:	01/09/2008
Last Update Date	:	04/09/2024

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