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NPI Code Detail

MEDICARE: JEREMY MATHENIA PA-C

MEDICARE: JEREMY MATHENIA 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 Assistant085-004144IL
2363AM0700XMedical Physician Assistant085004144IL
3363AM0700XMedical Physician AssistantVI
4363AM0700XMedical Physician Assistant105VI

General Provider Information

NPI Number : 1285910059
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEREMY MATHENIA PA-C
Provider Business Mailing Address
First Line : 6500 RED HOOK PLZ STE 205
Second Line :
City : ST THOMAS
State : VI
Zip : 00802-1346
Country : US
Telephone Number : 340-775-2303
Fax Number :
Provider Business Practice Location Address
First Line : 6500 RED HOOK PLZ STE 205
Second Line :
City : ST THOMAS
State : VI
Zip : 00802-1346
Country : US
Telephone Number : 340-775-2303
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2011
Last Update Date : 09/10/2024

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Directions to “ JEREMY MATHENIA PA-C” Practice Location

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