MEDICARE: EZDOCTORSRX.COM 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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1639461692
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EZDOCTORSRX.COM INC.

Provider Business Mailing Address
First Line	:	1621 WILLOW ST
Second Line	:
City	:	VINCENNES
State	:	IN
Zip	:	47591-4211
Country	:	US
Telephone Number	:	812-882-2400
Fax Number	:	812-882-2422

Provider Business Practice Location Address
First Line	:	1621 WILLOW ST
Second Line	:
City	:	VINCENNES
State	:	IN
Zip	:	47591-4211
Country	:	US
Telephone Number	:	812-882-2400
Fax Number	:	812-882-2422

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. LISA D STEEL
Credential	:	CPC
Telephone Number	:	812-882-2400

Provider Enumeration Date	:	05/10/2011
Last Update Date	:	05/10/2011

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