MEDICARE: MEDFUND 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	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center	HCC5210	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	V2645	OTHER	FL	BCBS PROVIDER NUMBER
2	3411979	OTHER		AETNA HMO PROVIDER NUMBER
3	5079697	OTHER		AETNA PPO/POS PROV NUMBER

General Provider Information

NPI Number	:	1861495087
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDFUND LLC

Provider Business Mailing Address
First Line	:	240 N WASHINGTON BLVD
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34236-5945
Country	:	US
Telephone Number	:	941-925-3490
Fax Number	:	951-953-4452

Provider Business Practice Location Address
First Line	:	6220 MANATEE AVE W
Second Line	:	STE 101
City	:	BRADENTON
State	:	FL
Zip	:	34209-2303
Country	:	US
Telephone Number	:	941-761-8594
Fax Number	:	941-761-3815

Authorized Official
Title or Position	:	SENIOR VICE PRESIDENT
Name	:	MR. MARTIN J. KERN
Credential	:
Telephone Number	:	941-925-3490

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	08/22/2020

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