=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518931617
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RICHARD MOLINSKI P.A.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2006
-----------------------------------------------------
Last Update Date | 05/30/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CAMP ATTERBURY 7812 MSU DET 1
-----------------------------------------------------
City | EDINBURGH
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-304-6571
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | CAMP ATTERBURY 7812 MSU DET 1
-----------------------------------------------------
City | APO
-----------------------------------------------------
State | AA
-----------------------------------------------------
Zip | 46124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-304-6571
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA 2401
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | PA2401
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------