JACK D RUNYAN (NPI# 1245476282) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245476282 |
| Entity Type | Individual |
| Full Name | JACK D RUNYAN |
| Credential | PA, PHD |
| Practice Address |
734 W Commerce St Fairfield TX 75840 |
| Mailing Address |
734 W Commerce St Fairfield TX 75840-1428 |
| Practice Telephone | 9565724000 |
| Mailing Telephone | 9033892181 |
| Mailing Fax Number | 9033890901 |
| Enumeration Date | 2008-12-22 |
| Last Update Date | 2018-08-07 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA 01154 | TX | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
734 W COMMERCE ST |
| City | FAIRFIELD |
| State | TX |
| Zip Code | 75840 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710986807 | East Texas Medical Center Home Services | Hospice Care, Community Based | 734 W Commerce St, Fairfield, TX 75840-1406 | 2005-07-20 |
| 1184180044 | Kayla Sierra Farmer | Nurse Practitioner | 734 W Commerce St, Fairfield, TX 75840-1428 | 2019-02-15 |
| 1316423452 | Tonya N Basque | Nurse Practitioner | 734 W Commerce St, Fairfield, TX 75840 | 2018-07-12 |
| 1568987071 | Stacy Ann Gallegos | Nurse Practitioner | 734 W Commerce St, Fairfield, TX 75840-1428 | 2017-08-04 |
| 1093263501 | Fairfield Hospital District | Clinic/Center | 734 W Commerce St, Suite C, Fairfield, TX 75840-1428 | 2016-09-13 |
| 1871918565 | Mark Waweru | Family Medicine | 734 W Commerce St, Fairfield, TX 75840-1428 | 2014-03-04 |
| 1366879694 | Lora Kelly Brown | Physician Assistant | 734 W Commerce St, Fairfield, TX 75840-1428 | 2013-10-01 |
| 1427322585 | Mary Elias Sorial | Family Medicine | 734 W Commerce St, Fairfield, TX 75840-1428 | 2012-03-06 |
| 1154316974 | Darryl White | Family Medicine | 734 W Commerce St, Fairfield, TX 75840-1428 | 2005-09-19 |
| 1508859596 | Joseph R Berger IIi | Family Medicine | 734 W Commerce St, Fairfield, TX 75840-1428 | 2005-08-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811508724 | Caitlin Nicole Sieck | Physical Therapist | 375 A West Hwy 84, Fairfield, TX 75840 | 2020-08-13 |
| 1841816014 | Katie Randall | Licensed Practical Nurse | 115 Pr 1295, Fairfield, TX 75840 | 2020-06-23 |
| 1063574671 | Rural Rehab Providers, LLC | Physical Therapist | 375-a West Hwy 84, Fairfield, TX 75840 | 2006-12-14 |
| 1598854572 | Erin Maggard | Specialist | 375a W Hwy 84, Fairfield, TX 75840 | 2006-10-11 |
| 1003916453 | Brookshire Brothers Inc | Pharmacy | 300 West Hwy 84, Fairfield, TX 75840 | 2006-09-25 |
| 1003899501 | Air Evac Ems Inc | Ambulance | 160 Interstate 45 S, Fairfield, TX 75840 | 2005-11-29 |
| 1952681256 | Suzanne Castles | Physical Therapist | 375-a West Hwy 84, Fairfield, TX 75840 | 2011-08-18 |
| 1407945488 | Lisa Lott | Nurse Practitioner | 375a W Hwy 84, Fairfield, TX 75840 | 2006-10-11 |
| 1972692952 | David Lott | Physical Therapist | 375a W Hwy 84, Fairfield, TX 75840 | 2006-10-11 |
| 1811973936 | Brian J. Shultz | Chiropractor | 305 W Commerce St, Fairfield, TX 75840-1401 | 2005-12-20 |
| Find all providers in zip 75840 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225668205 | Melissa Hisako Reagan | Physician Assistant | 1261 Travis Blvd Ste 100, Fairfield, CA 94533-4804 | 2020-01-18 |
| 1467639385 | Akosua Rodriguez | Physician Assistant | 2720 Low Ct Fl 2, Fairfield, CA 94534-9771 | 2008-01-22 |
| 1215061775 | Terrelyn C Fernandez | Physician Assistant | 1620 Pennsylvania Ave Ste C, Fairfield, CA 94533-3509 | 2007-03-15 |
| 1679618318 | Jennifer Chapman | Physician Assistant | 1801 Fairfield Beach Rd, Fairfield, CT 06824-6524 | 2007-02-20 |
| 1336251610 | Douglas K Casperson | Physician Assistant | 223 W Main, Ste A, Fairfield, MT 59436-6503 | 2006-08-31 |
| 1437142379 | Kayla Shaye Bell | Physician Assistant | 213 Nw 11th Street, Suite A, Fairfield, IL 62837 | 2005-08-25 |
| 1629513270 | Emily Elizabeth Helling | Physician Assistant | 2000 S Main St, Fairfield, IA 52556-9572 | 2017-01-05 |
| 1821546607 | Danielle Marie Centone | Physician Assistant | 75 Kings Highway Cutoff, Fairfield, CT 06824-5340 | 2016-09-21 |
| 1629431002 | Cassaundra Kalman Craig | Physician Assistant | 5390 Dixie Hwy, Fairfield, OH 45014-4124 | 2016-04-01 |
| 1457735540 | Emily Woodall | Physician Assistant | 3000 Mack Rd, Fairfield, OH 45014-5335 | 2015-07-17 |
| Find all providers in FAIRFIELD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.