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NPI Code Detail

MEDICARE: PHIL D JAQUITH PA

MEDICARE: PHIL D JAQUITH PA
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
1363AM0700XMedical Physician Assistant0462SD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1437150380
Entity Type Code : Individual
Provider Name (Legal Business Name) : PHIL D JAQUITH PA
Provider Business Mailing Address
First Line : 1104 W 8TH ST
Second Line :
City : YANKTON
State : SD
Zip : 57078-3306
Country : US
Telephone Number : 605-665-7841
Fax Number : 605-665-0546
Provider Business Practice Location Address
First Line : 101 S PLUM ST
Second Line :
City : VERMILLION
State : SD
Zip : 57069-3306
Country : US
Telephone Number : 605-624-8643
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/02/2005
Last Update Date : 08/13/2010

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Directions to “ PHIL D JAQUITH PA” Practice Location

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