MEDICARE: JONI CLINE PA

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	363AM0700X	Medical Physician Assistant	PA00226	TX
2	363A00000X	Physician Assistant	PA00226	TX

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	:	1629072277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONI CLINE PA

Provider Business Mailing Address
First Line	:	PO BOX 16327
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79490-6327
Country	:	US
Telephone Number	:	806-795-8150
Fax Number	:	806-791-6688

Provider Business Practice Location Address
First Line	:	4404 19TH ST STE C
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79407-2424
Country	:	US
Telephone Number	:	806-795-8150
Fax Number	:	806-791-6688

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

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	11/02/2007

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Directions to “ JONI CLINE PA” Practice Location

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