MEDICARE: INTENSIVE CARE CONSORTIUM 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	207RC0200X	Critical Care Medicine (Internal Medicine) Physician

General Provider Information

NPI Number	:	1124953278
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTENSIVE CARE CONSORTIUM INC

Provider Business Mailing Address
First Line	:	2000 HEALTH PARK DR
Second Line	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-4525
Country	:	US
Telephone Number	:	615-373-7406
Fax Number	:

Provider Business Practice Location Address
First Line	:	3651 WHEELER RD
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30909-6521
Country	:	US
Telephone Number	:	615-372-5068
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	CARLOS MOAS
Credential	:
Telephone Number	:	615-372-5068

Provider Enumeration Date	:	06/17/2026
Last Update Date	:	06/17/2026

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