MEDICARE: MAJOR IMPACT, 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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1104113810
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAJOR IMPACT, INC.

Provider Business Mailing Address
First Line	:	1960 VELASCO ST
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33916-2761
Country	:	US
Telephone Number	:	239-226-4357
Fax Number	:	239-226-4352

Provider Business Practice Location Address
First Line	:	1960 VELASCO ST
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33916-2761
Country	:	US
Telephone Number	:	239-226-4357
Fax Number	:	239-226-4352

Authorized Official
Title or Position	:	OWNER
Name	:	MR. CLAYTON LAMBERT MAJOR SR.
Credential	:	M.S.
Telephone Number	:	239-822-8401

Provider Enumeration Date	:	07/01/2011
Last Update Date	:	07/01/2011

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