MEDICARE: DR. CHARLIE WARE AP, 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	171100000X	Acupuncturist	AP2677	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3999711	OTHER	FL	COVENTRY HEALTH CARE OF FLORIDA
2	C00E6	OTHER	FL	BLUE CROSS BLUE SHIELD OF FLORIDA

General Provider Information

NPI Number	:	1174924955
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. CHARLIE WARE AP, LLC

Provider Business Mailing Address
First Line	:	2632 HOLLYWOOD BLVD
Second Line	:	SUITE 300
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-4857
Country	:	US
Telephone Number	:	954-458-5999
Fax Number	:	954-458-5990

Provider Business Practice Location Address
First Line	:	2632 HOLLYWOOD BLVD
Second Line	:	SUITE 300
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-4857
Country	:	US
Telephone Number	:	954-458-5999
Fax Number	:	954-458-5990

Authorized Official
Title or Position	:	ACUPUNCTURIST/OWNER
Name	:	DR. CHARLIE J. WARE
Credential	:	AP
Telephone Number	:	305-498-4483

Provider Enumeration Date	:	09/11/2014
Last Update Date	:	09/11/2014

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