MEDICARE: ANTHONY J SCARDINA PA-C

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	08500268	IL

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	970019987	OTHER	IL	RR MEDICARE

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	IL0102	OTHER	IL	JOHN DEERE
2	7230175	OTHER	IL	BLUE CROSS BLUE SHIELD
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	021651	OTHER	IL	HEALTH ALLIANCE
6	4281670001	OTHER	IL	DME

NPI Number	:	1508810771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY J SCARDINA PA-C

Provider Business Mailing Address
First Line	:	180 SOUTH MAIN STREET
Second Line	:
City	:	CANTON
State	:	IL
Zip	:	61520-2608
Country	:	US
Telephone Number	:	309-647-0201
Fax Number	:	309-649-5101

Provider Business Practice Location Address
First Line	:	180 SOUTH MAIN STREET
Second Line	:
City	:	CANTON
State	:	IL
Zip	:	61520-2608
Country	:	US
Telephone Number	:	309-647-0201
Fax Number	:	309-649-6880

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

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	04/13/2021

2050 CUMMING HWY , SUITE 100
CANTON, GA
30114-8614

Practice Phone: 770-345-9600
Practice Fax: