MEDICARE: AEGIS GROUP PRACTICE LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	225X00000X	Occupational Therapist
2	235Z00000X	Speech-Language Pathologist
3	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1659097178
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AEGIS GROUP PRACTICE LLC

Provider Business Mailing Address
First Line	:	2601 NETWORK BLVD STE 102
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75034-9092
Country	:	US
Telephone Number	:	972-372-6779
Fax Number	:	479-668-0872

Provider Business Practice Location Address
First Line	:	3000 MCGEE AVE
Second Line	:
City	:	MIDDLETOWN
State	:	OH
Zip	:	45044-4991
Country	:	US
Telephone Number	:	800-444-6845
Fax Number	:	479-478-2852

Authorized Official
Title or Position	:	CONTRACT/CREDENTIALING SPECIALIST
Name	:	MISTY S WILSON
Credential	:
Telephone Number	:	972-372-6779

Provider Enumeration Date	:	10/17/2022
Last Update Date	:	10/17/2022

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Directions to “AEGIS GROUP PRACTICE LLC ” Practice Location

Language	Start Address	Practice Location

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