# JUSTIN TYLER RUNEY

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1336490739
- **Gender:** Man
- **Credential:** PA-C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363AM0700X | Medical Physician Assistant | PA 1842 | SC | — |
| 363AS0400X | Surgical Physician Assistant | PA 1842 | SC | Yes |

## Other

- **Enumeration date:** 09/25/2012
- **Last updated:** 03/13/2020

## 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 |