MEDICARE: TERRENCE SCHWARTZ 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	363A00000X	Physician Assistant	TL#541	WY
2	363A00000X	Physician Assistant	PA-1044	ID

General Provider Information

NPI Number	:	1558632778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRENCE SCHWARTZ PA-C

Provider Business Mailing Address
First Line	:	PO BOX 266
Second Line	:
City	:	GLENNS FERRY
State	:	ID
Zip	:	83623-0266
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	350 MAIN STREET
Second Line	:
City	:	GRAND VIEW
State	:	ID
Zip	:	83624
Country	:	US
Telephone Number	:	120-883-4292
Fax Number	:

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

Provider Enumeration Date	:	01/19/2012
Last Update Date	:	11/18/2021

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