MEDICARE: MEDICAL ANALYSIS

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	3336C0003X	Community/Retail Pharmacy	05972	MS

General Provider Information

NPI Number	:	1104911221
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL ANALYSIS

Provider Business Mailing Address
First Line	:	1025 DIVISION ST.
Second Line	:	SUITE E
City	:	BILOXI
State	:	MS
Zip	:	39530
Country	:	US
Telephone Number	:	228-385-2550
Fax Number	:	228-432-7071

Provider Business Practice Location Address
First Line	:	250 BEAUVOIR RD # B
Second Line	:	SUITE 5
City	:	BILOXI
State	:	MS
Zip	:	39531-4026
Country	:	US
Telephone Number	:	228-385-2550
Fax Number	:	228-388-9861

Authorized Official
Title or Position	:	OWNER
Name	:	MR. GEORGE PITALO JR.
Credential	:
Telephone Number	:	228-432-7071

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	03/10/2017

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