MEDICARE: MEDI-BILL PLUS 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	3245S0500X	Children's Substance Abuse Rehabilitation Facility
2	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1740572239
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDI-BILL PLUS INC.

Provider Business Mailing Address
First Line	:	PO BOX 17244
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33318-7244
Country	:	US
Telephone Number	:	954-336-3310
Fax Number	:

Provider Business Practice Location Address
First Line	:	2040 NW 28TH ST
Second Line	:
City	:	OAKLAND PARK
State	:	FL
Zip	:	33311-2116
Country	:	US
Telephone Number	:	954-336-3310
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MIYOSHI AGNEW
Credential	:	CBCS
Telephone Number	:	954-336-3310

Provider Enumeration Date	:	05/03/2011
Last Update Date	:	05/03/2011

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