MEDICARE: MR. DAVID J YORK PAC

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	363AS0400X	Surgical Physician Assistant	PA834	KY
2	363AS0400X	Surgical Physician Assistant	10000605A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000318604	OTHER		ANTHEM BLUE CROSS

General Provider Information

NPI Number	:	1568467686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID J YORK PAC

Provider Business Mailing Address
First Line	:	2200 E PARRISH AVE
Second Line	:	BLDG D SUITE 100
City	:	OWENSBORO
State	:	KY
Zip	:	42303-1449
Country	:	US
Telephone Number	:	270-688-1770
Fax Number	:	270-688-1781

Provider Business Practice Location Address
First Line	:	2200 E PARRISH AVE
Second Line	:	BLDG D SUITE 100
City	:	OWENSBORO
State	:	KY
Zip	:	42303-1449
Country	:	US
Telephone Number	:	270-688-1770
Fax Number	:	270-688-1781

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

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	07/08/2013

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Directions to “ MR. DAVID J YORK PAC” Practice Location

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