Healthcare Provider Details

I. General information

NPI: 1023678307
Provider Name (Legal Business Name): WILLIAM ASHTON MCGUIRE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2019
Last Update Date: 06/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2805 5TH ST
RAPID CITY SD
57701-6003
US

IV. Provider business mailing address

27 RAVENWOOD DR
JACKSON TN
38305-8595
US

V. Phone/Fax

Practice location:
  • Phone: 605-755-5700
  • Fax:
Mailing address:
  • Phone: 731-225-3455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: