MEDICARE: LAWNWOOD PAVILION PHYSICIAN SERVICES 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	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1649261215
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAWNWOOD PAVILION PHYSICIAN SERVICES LLC

Provider Business Mailing Address
First Line	:	1870 N LAWNWOOD CIR
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-4828
Country	:	US
Telephone Number	:	772-467-3948
Fax Number	:	772-467-3953

Provider Business Practice Location Address
First Line	:	1870 N LAWNWOOD CIR
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-4828
Country	:	US
Telephone Number	:	772-467-3948
Fax Number	:	772-467-3953

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. PATRICK BIRMINGHAM
Credential	:
Telephone Number	:	615-373-7625

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	02/29/2008

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