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NPI Code Detail

MEDICARE: BILLY E. IVES JR. PA-C

MEDICARE: BILLY E. IVES JR. 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
1363A00000XPhysician Assistant146165NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1U3528OTHERFLBCBS FL

General Provider Information

NPI Number : 1285660886
Entity Type Code : Individual
Provider Name (Legal Business Name) : BILLY E. IVES JR. PA-C
Provider Business Mailing Address
First Line : PO BOX 863407
Second Line :
City : ORLANDO
State : FL
Zip : 32886-3407
Country : US
Telephone Number : 941-917-2600
Fax Number : 941-917-7884
Provider Business Practice Location Address
First Line : 1921 WALDEMERE ST STE 504
Second Line :
City : SARASOTA
State : FL
Zip : 34239-2941
Country : US
Telephone Number : 941-917-8525
Fax Number : 941-917-8526
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2006
Last Update Date : 01/22/2026

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