MEDICARE: HELIXCARE MEDICAL GROUP, LLC

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	208800000X	Urology Physician

General Provider Information

NPI Number	:	1164725529
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HELIXCARE MEDICAL GROUP, LLC

Provider Business Mailing Address
First Line	:	28227 THREE NOTCH RD
Second Line	:
City	:	MECHANICSVILLE
State	:	MD
Zip	:	20659-3239
Country	:	US
Telephone Number	:	301-884-8161
Fax Number	:

Provider Business Practice Location Address
First Line	:	28227 THREE NOTCH RD
Second Line	:
City	:	MECHANICSVILLE
State	:	MD
Zip	:	20659-3239
Country	:	US
Telephone Number	:	301-884-8161
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING/PAYOR SPECIALIST
Name	:	JAMIE STEELE-WHITE
Credential	:
Telephone Number	:	410-933-3073

Provider Enumeration Date	:	12/07/2010
Last Update Date	:	12/07/2010

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