MEDICARE: EMERGENCY MEDICAL FOUNDATION INC

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	3416L0300X	Land Ambulance	2959	FL

General Provider Information

NPI Number	:	1235292129
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMERGENCY MEDICAL FOUNDATION INC

Provider Business Mailing Address
First Line	:	112 CARSWELL AVE
Second Line	:
City	:	HOLLY HILL
State	:	FL
Zip	:	32117-5010
Country	:	US
Telephone Number	:	386-252-4900
Fax Number	:	386-252-4986

Provider Business Practice Location Address
First Line	:	112 CARSWELL AVE
Second Line	:
City	:	HOLLY HILL
State	:	FL
Zip	:	32117-5010
Country	:	US
Telephone Number	:	386-252-4900
Fax Number	:	386-252-4986

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. MICHAEL J MELLON
Credential	:
Telephone Number	:	386-252-4900

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	04/16/2008

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