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NPI Code Detail

MEDICARE: MS. JANA W DEMIZIO PA-C

MEDICARE: MS. JANA W DEMIZIO 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
1363A00000XPhysician Assistant824SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1790767697
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JANA W DEMIZIO PA-C
Provider Business Mailing Address
First Line : 300 E MCBEE AVE FL 4
Second Line :
City : GREENVILLE
State : SC
Zip : 29601-2842
Country : US
Telephone Number : 864-522-8603
Fax Number :
Provider Business Practice Location Address
First Line : 300 SCUFFLETOWN RD
Second Line :
City : SIMPSONVILLE
State : SC
Zip : 29681-7204
Country : US
Telephone Number : 864-522-1550
Fax Number : 864-522-1555
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/16/2005
Last Update Date : 10/16/2024

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