MEDICARE: ROBBIE BOYD MARCANTEL PAC

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	PAA10386RX	LA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P000014188	OTHER	LA	RAILROAD MEDICARE PALMETT

General Provider Information

NPI Number	:	1659345502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBBIE BOYD MARCANTEL PAC

Provider Business Mailing Address
First Line	:	PO BOX 2780
Second Line	:
City	:	JENA
State	:	LA
Zip	:	71342-2780
Country	:	US
Telephone Number	:	318-992-9200
Fax Number	:	318-992-9280

Provider Business Practice Location Address
First Line	:	180 NINTH ST
Second Line	:
City	:	JENA
State	:	LA
Zip	:	71342-3900
Country	:	US
Telephone Number	:	318-992-9268
Fax Number	:	318-992-6201

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

Provider Enumeration Date	:	02/16/2006
Last Update Date	:	01/11/2017

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Directions to “ ROBBIE BOYD MARCANTEL PAC” Practice Location

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