MEDICARE: MEDFUND 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	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	242896	OTHER		AMERIGROUP PROV #
2	7169328	OTHER		AETNA/MEDSOLUTIONS
3	0265DC	OTHER	TX	BCBS PROVIDER #

General Provider Information

NPI Number	:	1275536229
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDFUND LLC

Provider Business Mailing Address
First Line	:	240 N WASHINGTON BLVD
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34236-5945
Country	:	US
Telephone Number	:	941-925-3490
Fax Number	:	941-953-4452

Provider Business Practice Location Address
First Line	:	325 N SHILOH RD
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75042-6610
Country	:	US
Telephone Number	:	972-494-6745
Fax Number	:	972-494-6788

Authorized Official
Title or Position	:	SENIOR VICE PRESIDENT
Name	:	MR. MARTIN J KERN
Credential	:
Telephone Number	:	941-925-3490

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	08/22/2020

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Directions to “MEDFUND LLC ” Practice Location

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