MEDICARE: EXCELLENT GROUP SERVICES 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	261QM1300X	Multi-Specialty Clinic/Center	MM25210	FL

General Provider Information

NPI Number	:	1558674010
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXCELLENT GROUP SERVICES INC

Provider Business Mailing Address
First Line	:	10550 NW 77 CT #310
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33016-2072
Country	:	US
Telephone Number	:	305-558-3033
Fax Number	:	305-558-3059

Provider Business Practice Location Address
First Line	:	10550 NW 77TH CT STE 310
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33016-2072
Country	:	US
Telephone Number	:	305-558-3033
Fax Number	:	305-558-3059

Authorized Official
Title or Position	:	CHIROPRACTOR/PRESIDENT
Name	:	MRS. CATALINA TORRES
Credential	:	DC
Telephone Number	:	305-558-3033

Provider Enumeration Date	:	07/26/2010
Last Update Date	:	07/26/2010

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