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NPI Code Detail

MEDICARE: MR. JASON ALLEN KOCIAN P.A.

MEDICARE: MR. JASON ALLEN KOCIAN P.A.
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 AssistantMA063551PA
2363AS0400XSurgical Physician AssistantPA154902OR

General Provider Information

NPI Number : 1467653378
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JASON ALLEN KOCIAN P.A.
Provider Business Mailing Address
First Line : PO BOX 74008272
Second Line :
City : CHICAGO
State : IL
Zip : 60674-8272
Country : US
Telephone Number : 702-899-0595
Fax Number : 702-977-1496
Provider Business Practice Location Address
First Line : 685 ANGELA DR
Second Line :
City : GREENSBURG
State : PA
Zip : 15601-2655
Country : US
Telephone Number : 702-899-0595
Fax Number : 702-977-1496
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/29/2007
Last Update Date : 10/02/2025

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