MEDICARE: IC OPPORTUNITIES

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	251K00000X	Public Health or Welfare Agency	RN122966	TN

General Provider Information

NPI Number	:	1356625891
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IC OPPORTUNITIES

Provider Business Mailing Address
First Line	:	PO BOX 50560
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37205-0560
Country	:	US
Telephone Number	:	615-210-8411
Fax Number	:

Provider Business Practice Location Address
First Line	:	521 5TH AVE S
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37203-4211
Country	:	US
Telephone Number	:	615-210-8411
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. IRENE BRADLEY
Credential	:	RN
Telephone Number	:	615-210-8411

Provider Enumeration Date	:	10/03/2011
Last Update Date	:	10/03/2011

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