MEDICARE: RACHEL HAND PAC

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	PA03975	TX
2	363AM0700X	Medical Physician Assistant	15-01384	KS
3	363AM0700X	Medical Physician Assistant	2012016494	MO
4	363AM0700X	Medical Physician Assistant	2524	OK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P01102070	OTHER		RAILROAD MEDICARE

General Provider Information

NPI Number	:	1033112347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL HAND PAC

Provider Business Mailing Address
First Line	:	1122 NE 13TH ST
Second Line	:	ORB 150
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73117-1039
Country	:	US
Telephone Number	:	405-271-8558
Fax Number	:

Provider Business Practice Location Address
First Line	:	1122 NE 13TH ST
Second Line	:	ORB 1200
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73117-1039
Country	:	US
Telephone Number	:	405-271-8558
Fax Number	:	405-271-3887

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	12/03/2015

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Directions to “ RACHEL HAND PAC” Practice Location

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