MEDICARE: ORION CARDIOVASCULAR, III

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	261QM2500X	Medical Specialty Clinic/Center	ME82977	FL

General Provider Information

NPI Number	:	1790971364
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORION CARDIOVASCULAR, III

Provider Business Mailing Address
First Line	:	PO BOX 1447
Second Line	:
City	:	FT. PIERCE
State	:	FL
Zip	:	34954
Country	:	US
Telephone Number	:	772-466-1467
Fax Number	:	772-466-1595

Provider Business Practice Location Address
First Line	:	1803 S 25TH STREET
Second Line	:	STE 1
City	:	FT. PIERCE
State	:	FL
Zip	:	34947
Country	:	US
Telephone Number	:	772-466-1467
Fax Number	:	772-466-1595

Authorized Official
Title or Position	:	CEO
Name	:	DR. ANTHONY B LEWIS
Credential	:	M.D.
Telephone Number	:	772-466-1567

Provider Enumeration Date	:	09/18/2007
Last Update Date	:	09/18/2007

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