MEDICARE: PARADISE VETERINARY PRACTICE PC

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	174M00000X	Veterinarian	002884-1	NY

General Provider Information

NPI Number	:	1841421278
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARADISE VETERINARY PRACTICE PC

Provider Business Mailing Address
First Line	:	4073 WARNER ROAD
Second Line	:
City	:	MARION
State	:	NY
Zip	:	14505-9328
Country	:	US
Telephone Number	:	315-926-5358
Fax Number	:	315-926-5359

Provider Business Practice Location Address
First Line	:	4073 WARNER ROAD
Second Line	:
City	:	MARION
State	:	NY
Zip	:	14505-9328
Country	:	US
Telephone Number	:	315-926-5358
Fax Number	:	315-926-5359

Authorized Official
Title or Position	:	VETERINARIAN AND OWNER OF PARADISE
Name	:	DR. DAVID FARLEY SCOVILLE
Credential	:	DVM
Telephone Number	:	315-926-5358

Provider Enumeration Date	:	08/03/2009
Last Update Date	:	08/03/2009

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