Healthcare Provider Details

I. General information

NPI: 1922815059
Provider Name (Legal Business Name): CHEYENNE BILICA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2024
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 PLAZA DR
SAINT CLAIRSVILLE OH
43950-8736
US

IV. Provider business mailing address

380 SUMMIT AVENUE, MSO PHYSICIAN BILLING
STUBENVILLE OH
43952
US

V. Phone/Fax

Practice location:
  • Phone: 740-695-1673
  • Fax: 234-285-6816
Mailing address:
  • Phone: 740-283-7776
  • Fax: 740-283-7807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.009600RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: