MEDICARE: LOTUS CENTER OF HEALING, 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	171100000X	Acupuncturist	AP2765	FL

General Provider Information

NPI Number	:	1629394135
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOTUS CENTER OF HEALING, LLC

Provider Business Mailing Address
First Line	:	12716 COOL WATER WAY
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-5135
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1420 3RD ST N
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-7350
Country	:	US
Telephone Number	:	904-616-4934
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	JOY ESLER
Credential	:	A.P.
Telephone Number	:	904-616-4934

Provider Enumeration Date	:	04/09/2010
Last Update Date	:	07/22/2010

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