MEDICARE: MRS. ELISKA C WEBSTER 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	174400000X	Specialist	15-00708	KS
2	363A00000X	Physician Assistant	2018017186	MO
3	363A00000X	Physician Assistant	PA.0008283	CO

General Provider Information

NPI Number	:	1144221029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELISKA C WEBSTER PA-C

Provider Business Mailing Address
First Line	:	100 NW MOCK AVE STE 200
Second Line	:
City	:	BLUE SPRINGS
State	:	MO
Zip	:	64014-2500
Country	:	US
Telephone Number	:	816-228-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	131 STANLEY AVE STE 202
Second Line	:
City	:	ESTES PARK
State	:	CO
Zip	:	80517-6356
Country	:	US
Telephone Number	:	970-586-2343
Fax Number	:

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

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	12/26/2023

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