=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366638454
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAXWELL MEDICAL PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2007
-----------------------------------------------------
Last Update Date | 02/05/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4020 US 27 N
-----------------------------------------------------
City | SEBRING
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33870-1333
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-314-0020
-----------------------------------------------------
Fax | 863-314-0024
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4020 US 27 N
-----------------------------------------------------
City | SEBRING
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33870-1333
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-314-0020
-----------------------------------------------------
Fax | 863-314-0024
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MARVIN D MAXWELL
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 863-314-0020
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | ME67256
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------