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NPI Code Detail

MEDICARE: CHARLES JOSEPH AMY PA-C

MEDICARE: CHARLES JOSEPH AMY 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
1363AM0700XMedical Physician Assistant72WY

General Provider Information

NPI Number : 1679512305
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES JOSEPH AMY PA-C
Provider Business Mailing Address
First Line : PO BOX 219
Second Line :
City : GREEN RIVER
State : WY
Zip : 82935-0219
Country : US
Telephone Number : 307-872-4500
Fax Number : 307-872-4595
Provider Business Practice Location Address
First Line : 1400 UINTA DR
Second Line :
City : GREEN RIVER
State : WY
Zip : 82935-5046
Country : US
Telephone Number : 307-872-4500
Fax Number : 307-872-4595
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2006
Last Update Date : 06/16/2015

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Directions to “ CHARLES JOSEPH AMY PA-C” Practice Location

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