MEDICARE: ON CALL, INC

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	363AS0400X	Surgical Physician Assistant

General Provider Information

NPI Number	:	1043536402
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ON CALL, INC

Provider Business Mailing Address
First Line	:	6660 ASHBURN RD
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-7316
Country	:	US
Telephone Number	:	800-872-1404
Fax Number	:	561-966-0531

Provider Business Practice Location Address
First Line	:	6660 ASHBURN RD
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-7316
Country	:	US
Telephone Number	:	800-872-1404
Fax Number	:	561-966-0531

Authorized Official
Title or Position	:	PREISDENT
Name	:	MR. GARY D GOTTLIEB
Credential	:	PA-C
Telephone Number	:	561-762-6354

Provider Enumeration Date	:	04/10/2010
Last Update Date	:	04/10/2010

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