MEDICARE: WILLIAM VASCIK PA-C, MPAS, MS, ATC

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	PA9106354	FL

General Provider Information

NPI Number	:	1639355373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM VASCIK PA-C, MPAS, MS, ATC

Provider Business Mailing Address
First Line	:	3210 CLEVELAND AVE
Second Line	:	#100
City	:	FORT MYERS
State	:	FL
Zip	:	33901-7180
Country	:	US
Telephone Number	:	239-936-6778
Fax Number	:

Provider Business Practice Location Address
First Line	:	3210 CLEVELAND AVE
Second Line	:	#100
City	:	FORT MYERS
State	:	FL
Zip	:	33901-7180
Country	:	US
Telephone Number	:	239-936-6778
Fax Number	:

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

Provider Enumeration Date	:	01/11/2008
Last Update Date	:	12/08/2011

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