MEDICARE: ANDREA J BIEGANSKI 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	363AS0400X	Surgical Physician Assistant	1001	NE
2	363A00000X	Physician Assistant	PA.0002234	CO

General Provider Information

NPI Number	:	1801883525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA J BIEGANSKI P.A.

Provider Business Mailing Address
First Line	:	2001 S SHIELDS ST BLDG E
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-1827
Country	:	US
Telephone Number	:	970-493-5334
Fax Number	:	970-493-3727

Provider Business Practice Location Address
First Line	:	2001 S SHIELDS ST BLDG E
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-1827
Country	:	US
Telephone Number	:	970-493-5334
Fax Number	:	970-493-3727

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

Provider Enumeration Date	:	09/29/2005
Last Update Date	:	10/18/2021

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