MEDICARE: OMSA SATELLITE, CORP.

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	16203	FL

General Provider Information

NPI Number	:	1003141730
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OMSA SATELLITE, CORP.

Provider Business Mailing Address
First Line	:	10173 W SUNRISE BLVD
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33322-7617
Country	:	US
Telephone Number	:	954-693-0026
Fax Number	:	954-693-0085

Provider Business Practice Location Address
First Line	:	10173 W SUNRISE BLVD
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33322-7617
Country	:	US
Telephone Number	:	954-693-0026
Fax Number	:	954-693-0085

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RAMON A PEREZ-ROSICH
Credential	:	DMD
Telephone Number	:	954-693-0026

Provider Enumeration Date	:	10/14/2009
Last Update Date	:	10/14/2009

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Directions to “OMSA SATELLITE, CORP. ” Practice Location

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