MEDICARE: DR. JASON DAVID BANISTER MD

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	208600000X	Surgery Physician	32967	KY

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

General Provider Information

NPI Number	:	1336218031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON DAVID BANISTER MD

Provider Business Mailing Address
First Line	:	PO BOX 636961
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-6961
Country	:	US
Telephone Number	:	513-981-5130
Fax Number	:	513-981-5015

Provider Business Practice Location Address
First Line	:	225 MEDICAL CENTER DR
Second Line	:	STE 205
City	:	PADUCAH
State	:	KY
Zip	:	42003-7907
Country	:	US
Telephone Number	:	270-441-4462
Fax Number	:	270-441-4461

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

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	11/25/2014

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