MEDICARE: PHYLLIS ELAINE MCALLISTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1114112844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHYLLIS ELAINE MCALLISTER

Provider Business Mailing Address
First Line	:	801 SW AVENUE J
Second Line	:
City	:	BELLE GLADE
State	:	FL
Zip	:	33430-4233
Country	:	US
Telephone Number	:	561-992-9716
Fax Number	:	561-993-8750

Provider Business Practice Location Address
First Line	:	801 SW AVENUE J
Second Line	:
City	:	BELLE GLADE
State	:	FL
Zip	:	33430-4233
Country	:	US
Telephone Number	:	561-992-9716
Fax Number	:	561-993-8750

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2007
Last Update Date	:	09/06/2007

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Directions to “ PHYLLIS ELAINE MCALLISTER ” Practice Location

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