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NPI Code Detail

MEDICARE: DR. JASON JOHN STACY M.D.

MEDICARE: DR. JASON JOHN STACY M.D.
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
1207Q00000XFamily Medicine Physician24051SC
2207QS0010XSports Medicine (Family Medicine) Physician24051SC

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10534520001OTHERSCMEDICARE DME

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1831164334
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JASON JOHN STACY M.D.
Provider Business Mailing Address
First Line : 3209 COLONIAL DR
Second Line :
City : COLUMBIA
State : SC
Zip : 29203-6930
Country : US
Telephone Number : 803-434-6116
Fax Number : 803-434-7529
Provider Business Practice Location Address
First Line : 3209 COLONIAL DR
Second Line :
City : COLUMBIA
State : SC
Zip : 29203-6930
Country : US
Telephone Number : 803-434-6113
Fax Number : 803-434-7231
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/20/2006
Last Update Date : 04/02/2010

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Directions to “ DR. JASON JOHN STACY M.D.” Practice Location

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