MEDICARE: JONI M STRUCKMAN 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	01260	WV
2	363A00000X	Physician Assistant	454	WV

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	:	1619059177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONI M STRUCKMAN PA C

Provider Business Mailing Address
First Line	:	PO BOX 337
Second Line	:
City	:	SCARBRO
State	:	WV
Zip	:	25917
Country	:	US
Telephone Number	:	304-465-1378
Fax Number	:	304-469-2981

Provider Business Practice Location Address
First Line	:	850 INDEPENDENCE ROAD
Second Line	:
City	:	COAL CITY
State	:	WV
Zip	:	25823-1595
Country	:	US
Telephone Number	:	304-469-2905
Fax Number	:	304-683-6906

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

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	05/18/2020

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