Provider Demographics
NPI:1962474361
Name:JICHA, GEORGE J (PA)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:J
Last Name:JICHA
Suffix:
Gender:M
Credentials:PA
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:6653 MAIN STREET
Mailing Address - Street 2:THE EXIGENCE GROUP C O JANENE FARLEY
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221
Mailing Address - Country:US
Mailing Address - Phone:716-817-2932
Mailing Address - Fax:716-204-4501
Practice Address - Street 1:1800 E FLORENCE BLVD
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85222-5303
Practice Address - Country:US
Practice Address - Phone:520-381-6300
Practice Address - Fax:520-381-6618
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2012-08-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ2388363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ548745Medicaid
CAGH333ZMedicare PIN
P49158Medicare UPIN
AZ548745Medicaid