MEDICARE: CIRCLE OF SUPPORT

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	174400000X	Specialist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326164062
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CIRCLE OF SUPPORT

Provider Business Mailing Address
First Line	:	947 E CONSTITUTION DR
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85296-9755
Country	:	US
Telephone Number	:	480-857-2052
Fax Number	:	480-857-2052

Provider Business Practice Location Address
First Line	:	947 E CONSTITUTION DR
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85296-9755
Country	:	US
Telephone Number	:	480-857-2052
Fax Number	:	480-857-2052

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	JIM WOODARD
Credential	:
Telephone Number	:	480-857-2052

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	09/20/2007

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Directions to “CIRCLE OF SUPPORT ” Practice Location

Language	Start Address	Practice Location

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