MEDICARE: JARROD JOHN HENRY 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	PA1334	ME

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	838363	OTHER		MEDICARE GROUP ASSIGN
2	P00320656	OTHER		MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	838363	OTHER		BS GROUP ASSIGN

General Provider Information

NPI Number	:	1083687024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JARROD JOHN HENRY PA-C

Provider Business Mailing Address
First Line	:	12 SHUMAN AVE
Second Line	:
City	:	AUGUSTA
State	:	ME
Zip	:	04330-6020
Country	:	US
Telephone Number	:	207-622-8600
Fax Number	:	207-622-8601

Provider Business Practice Location Address
First Line	:	12 SHUMAN AVE
Second Line	:
City	:	AUGUSTA
State	:	ME
Zip	:	04330-6020
Country	:	US
Telephone Number	:	207-622-8600
Fax Number	:	207-622-8601

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

Provider Enumeration Date	:	02/09/2006
Last Update Date	:	08/23/2013

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Directions to “ JARROD JOHN HENRY PA-C” Practice Location

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