MEDICARE: MR. JASON BLAKELY HENSLER 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	PA03094	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	00772T	OTHER	TX	MEDICARE GRP#

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PA03094	OTHER	TX	LISCENSE NUMBER

General Provider Information

NPI Number	:	1356345763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JASON BLAKELY HENSLER PA-C

Provider Business Mailing Address
First Line	:	P.O. BOX 600
Second Line	:
City	:	EDINBURG
State	:	TX
Zip	:	78540-0600
Country	:	US
Telephone Number	:	956-661-8200
Fax Number	:	956-661-8205

Provider Business Practice Location Address
First Line	:	4865 N. MCCOLL RD.
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78504
Country	:	US
Telephone Number	:	956-661-8200
Fax Number	:	956-661-8205

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	02/21/2020

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Directions to “ MR. JASON BLAKELY HENSLER PA-C” Practice Location

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