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Individual
JUSTIN TYLER RUNEY
Active
Individual
JUSTIN TYLER RUNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
PA 1842
SC
363AS0400X
Surgical Physician Assistant
Primary
PA 1842
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1874PA
—
SC
01
—
1902246077
ARCIS HEALTHCARE GROUP NPI
SC
01
—
D043
ARCIS HEALTHCARE GROUP MEDICARE PTAN
SC
01
—
DU4331
ARCIS HEALTHCARE GROUP RAILROAD MEDICARE PTAN
SC
01
—
GP6337
ARCIS HEALTHCARE GROUP MEDICAID NO.
SC
01
—
P01337423
RAILROAD MEDICARE PTAN
SC
Enumeration date
09/25/2012
Last updated
03/13/2020
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