MEDICARE: JADE MEANS 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	OA003871	PA
2	363AM0700X	Medical Physician Assistant	MA003622L	PA

General Provider Information

NPI Number	:	1376548982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JADE MEANS PA-C

Provider Business Mailing Address
First Line	:	1824 GOOD HOPE RD
Second Line	:
City	:	ENOLA
State	:	PA
Zip	:	17025-1233
Country	:	US
Telephone Number	:	717-732-8877
Fax Number	:	717-732-9241

Provider Business Practice Location Address
First Line	:	1824 GOOD HOPE RD
Second Line	:
City	:	ENOLA
State	:	PA
Zip	:	17025-1233
Country	:	US
Telephone Number	:	717-732-8877
Fax Number	:	717-732-9241

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

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	05/19/2022

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Directions to “ JADE MEANS PA-C” Practice Location

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