MEDICARE: FORT PIERCE INTERMEDIATE CARE CENTER

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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1184753758
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORT PIERCE INTERMEDIATE CARE CENTER

Provider Business Mailing Address
First Line	:	900 VIRGINIA AVE
Second Line	:	SUITE 10
City	:	FORT PIERCE
State	:	FL
Zip	:	34982-5882
Country	:	US
Telephone Number	:	772-464-6551
Fax Number	:	772-465-0322

Provider Business Practice Location Address
First Line	:	900 VIRGINIA AVE
Second Line	:	SUITE 10
City	:	FORT PIERCE
State	:	FL
Zip	:	34982-5882
Country	:	US
Telephone Number	:	772-464-6551
Fax Number	:	772-465-0322

Authorized Official
Title or Position	:	VP
Name	:	CRAIG WALKER
Credential	:
Telephone Number	:	800-661-3365

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	08/22/2020

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