MEDICARE: DEBBI L STAATS 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	PA00645	OR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	383846	OTHER	OR	MEDICARE RHC PROVIDER NUM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	C91331	OTHER	OR	SUPERVISING MD'S UPIN

General Provider Information

NPI Number	:	1316984156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBBI L STAATS PA-C

Provider Business Mailing Address
First Line	:	1813 W HARVARD AVE
Second Line	:	STE 201
City	:	ROSEBURG
State	:	OR
Zip	:	97471-2754
Country	:	US
Telephone Number	:	541-440-6390
Fax Number	:	541-440-6392

Provider Business Practice Location Address
First Line	:	783 W CENTRAL
Second Line	:
City	:	SUTHERLIN
State	:	OR
Zip	:	97479-9472
Country	:	US
Telephone Number	:	541-459-3500
Fax Number	:	541-459-4040

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

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	11/19/2008

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Directions to “ DEBBI L STAATS PA-C” Practice Location

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