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NPI Code Detail

MEDICARE: JAMIE L FERENCAK PA

MEDICARE: JAMIE L FERENCAK PA
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 Assistant50-002190OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000358561OTHEROHANTHEM

General Provider Information

NPI Number : 1891767711
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMIE L FERENCAK PA
Provider Business Mailing Address
First Line : PO BOX 74647
Second Line :
City : CLEVELAND
State : OH
Zip : 44194-0730
Country : US
Telephone Number : 440-879-0081
Fax Number : 440-879-0084
Provider Business Practice Location Address
First Line : 4110 WARRENSVILLE CENTER RD
Second Line :
City : BEACHWOOD
State : OH
Zip : 44122-7024
Country : US
Telephone Number : 216-491-6000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/03/2006
Last Update Date : 07/11/2007

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Directions to “ JAMIE L FERENCAK PA” Practice Location

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