Provider Demographics
NPI:1568611077
Name:STEWART, JEREMIAH W (PA-C)
Entity Type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:W
Last Name:STEWART
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 W UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-3428
Mailing Address - Country:US
Mailing Address - Phone:260-969-1950
Mailing Address - Fax:260-918-2137
Practice Address - Street 1:2401 W UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-3428
Practice Address - Country:US
Practice Address - Phone:260-969-1950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10001038A363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000659921OtherANTHEM BC/BS
INP00712308OtherRAILROAD MEDICARE
INP00775323OtherRAILROAD MEDICARE
IN000000625946OtherANTHEM BC/BS
IN000000594502OtherANTHEM BC/BS
INP00841089OtherRAILROAD MEDICARE
INP00841089OtherRAILROAD MEDICARE
IN265520EMedicare PIN
IN261920TMedicare PIN
IN000000659921OtherANTHEM BC/BS
IN264430276Medicare PIN
INP00712308OtherRAILROAD MEDICARE