MEDICARE: MRS. BEVERLY LORRAINE TASCHE PAC

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	1500290	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0000427259	OTHER	KS	BLUE CROSS BLUE SHIELD OF KANSAS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932192416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BEVERLY LORRAINE TASCHE PAC

Provider Business Mailing Address
First Line	:	1525 MADISON ST
Second Line	:	STE 2
City	:	FREDONIA
State	:	KS
Zip	:	66736-1704
Country	:	US
Telephone Number	:	620-378-2068
Fax Number	:	620-378-2312

Provider Business Practice Location Address
First Line	:	1525 MADISON ST
Second Line	:	STE 2
City	:	FREDONIA
State	:	KS
Zip	:	66736-1704
Country	:	US
Telephone Number	:	620-378-2068
Fax Number	:	620-378-2312

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

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	01/04/2010

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