MEDICARE: PHYSICIAN HOUSE CALLS OF TEXAS 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	364SH0200X	Home Health Clinical Nurse Specialist	00578Z	TX

General Provider Information

NPI Number	:	1194995977
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICIAN HOUSE CALLS OF TEXAS LLC

Provider Business Mailing Address
First Line	:	2500 QUANTUM LAKES DR
Second Line	:	SUITE 108
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-8324
Country	:	US
Telephone Number	:	561-244-0220
Fax Number	:	561-244-0221

Provider Business Practice Location Address
First Line	:	1997 FOREST RIDGE DR
Second Line	:
City	:	BEDFORD
State	:	TX
Zip	:	76021-1825
Country	:	US
Telephone Number	:	561-244-0220
Fax Number	:	561-244-0221

Authorized Official
Title or Position	:	CFO
Name	:	MR. DANIEL CAMMARATA
Credential	:
Telephone Number	:	561-244-0220

Provider Enumeration Date	:	03/07/2008
Last Update Date	:	05/30/2008

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