MEDICARE: STACI MARIE MAGUIRE 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	5601007106	MI

General Provider Information

NPI Number	:	1578964102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACI MARIE MAGUIRE PA-C

Provider Business Mailing Address
First Line	:	363 FREMONT ST STE 101
Second Line	:
City	:	BATTLE CREEK
State	:	MI
Zip	:	49017-3395
Country	:	US
Telephone Number	:	269-245-8350
Fax Number	:	269-245-8345

Provider Business Practice Location Address
First Line	:	363 FREMONT ST STE 101
Second Line	:
City	:	BATTLE CREEK
State	:	MI
Zip	:	49017-3395
Country	:	US
Telephone Number	:	269-245-8350
Fax Number	:	269-245-8345

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

Provider Enumeration Date	:	09/15/2014
Last Update Date	:	09/22/2025

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