MEDICARE: INTRACARE HEALTH SERVICES

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	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)
2	208000000X	Pediatrics Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PS19129	OTHER	FL	FLORIDA BOARD OF PHARMACY

General Provider Information

NPI Number	:	1407468580
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTRACARE HEALTH SERVICES

Provider Business Mailing Address
First Line	:	160 SW 12TH AVE STE 101D
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33442-3114
Country	:	US
Telephone Number	:	888-327-2233
Fax Number	:	888-439-4453

Provider Business Practice Location Address
First Line	:	160 SW 12TH AVE STE 101D
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33442-3114
Country	:	US
Telephone Number	:	888-327-2233
Fax Number	:	888-439-4453

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MILES GILMAN
Credential	:	PHARMD
Telephone Number	:	888-327-2233

Provider Enumeration Date	:	08/19/2020
Last Update Date	:	06/13/2022

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Directions to “INTRACARE HEALTH SERVICES ” Practice Location

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