MEDICARE: A & G SPINAL SOLUTIONS LLC

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1609003573
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A & G SPINAL SOLUTIONS LLC

Provider Business Mailing Address
First Line	:	8695 COLLEGE PKWY
Second Line	:	SUITE 1197
City	:	FORT MYERS
State	:	FL
Zip	:	33919-4890
Country	:	US
Telephone Number	:	239-985-4138
Fax Number	:

Provider Business Practice Location Address
First Line	:	8695 COLLEGE PKWY
Second Line	:	SUITE 1197
City	:	FORT MYERS
State	:	FL
Zip	:	33919-4890
Country	:	US
Telephone Number	:	239-985-4138
Fax Number	:	239-362-2272

Authorized Official
Title or Position	:	OWNER
Name	:	MR. WILLIAM HENRY PIERCE III
Credential	:	LPTA
Telephone Number	:	239-985-4138

Provider Enumeration Date	:	06/17/2009
Last Update Date	:	08/13/2010

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