MEDICARE: HOSPICE ADVANTAGE MIDCO, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207QH0002X	Hospice and Palliative Medicine (Family Medicine) Physician
2	363LF0000X	Family Nurse Practitioner
3	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician

General Provider Information

NPI Number	:	1588348882
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOSPICE ADVANTAGE MIDCO, LLC

Provider Business Mailing Address
First Line	:	10 CADILLAC DR STE 400
Second Line	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-1001
Country	:	US
Telephone Number	:	417-841-4834
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 INTERNATIONAL PARK DR STE 200
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35243-4217
Country	:	US
Telephone Number	:	205-730-7980
Fax Number	:	205-968-4072

Authorized Official
Title or Position	:	SVP, CHIEF LEGAL OFFICER
Name	:	RUSSELL ADKINS
Credential	:
Telephone Number	:	615-309-5668

Provider Enumeration Date	:	06/15/2023
Last Update Date	:	06/15/2023

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