MEDICARE: EPIC SERVICES, 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	174400000X	Specialist	MM21223	FL

General Provider Information

NPI Number	:	1073768867
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EPIC SERVICES, LLC

Provider Business Mailing Address
First Line	:	10025 N DALE MABRY HWY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-4409
Country	:	US
Telephone Number	:	813-961-7306
Fax Number	:

Provider Business Practice Location Address
First Line	:	10025 N DALE MABRY HWY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-4409
Country	:	US
Telephone Number	:	813-961-7306
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. KELLY L HOBAN
Credential	:
Telephone Number	:	813-961-7306

Provider Enumeration Date	:	11/21/2008
Last Update Date	:	10/06/2009

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