MEDICARE: MARC LEWIS REITZNER P.A.

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	2006001738	MO

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790732162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARC LEWIS REITZNER P.A.

Provider Business Mailing Address
First Line	:	PO BOX 9007
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65808-9007
Country	:	US
Telephone Number	:	417-875-3462
Fax Number	:

Provider Business Practice Location Address
First Line	:	3800 S NATIONAL AVE
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65807-5209
Country	:	US
Telephone Number	:	417-875-3700
Fax Number	:

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

Provider Enumeration Date	:	05/30/2006
Last Update Date	:	12/27/2018

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