MEDICARE: OVP HEALTH CARE, 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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1083227615
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OVP HEALTH CARE, INC.

Provider Business Mailing Address
First Line	:	PO BOX 390
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25708-0390
Country	:	US
Telephone Number	:	304-429-1088
Fax Number	:	304-429-3109

Provider Business Practice Location Address
First Line	:	3471 BELLE TERRE BLVD STE A1
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-8405
Country	:	US
Telephone Number	:	304-429-1088
Fax Number	:	304-429-3109

Authorized Official
Title or Position	:	CREDENTIALING
Name	:	TARA LANDERS
Credential	:
Telephone Number	:	304-429-1088

Provider Enumeration Date	:	08/24/2020
Last Update Date	:	08/24/2020

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