MEDICARE: MISS KRISTA MARIE RUBOSKY 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	50.003759	OH
2	363AM0700X	Medical Physician Assistant	50.003759RX	OH
3	363A00000X	Physician Assistant	50.003759RX	OH

Other Identifiers

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

General Provider Information

NPI Number	:	1578805602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KRISTA MARIE RUBOSKY PA-C

Provider Business Mailing Address
First Line	:	6855 SPRING VALLEY DR STE 110
Second Line	:
City	:	HOLLAND
State	:	OH
Zip	:	43528-9374
Country	:	US
Telephone Number	:	218-438-0283
Fax Number	:	513-823-3247

Provider Business Practice Location Address
First Line	:	6855 SPRING VALLEY DR STE 110
Second Line	:
City	:	HOLLAND
State	:	OH
Zip	:	43528-9374
Country	:	US
Telephone Number	:	218-438-0283
Fax Number	:	513-823-3247

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

Provider Enumeration Date	:	03/27/2013
Last Update Date	:	05/29/2025

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