MEDICARE: THE MEDICAL INTERNET FOR HUMANITY

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	251K00000X	Public Health or Welfare Agency

General Provider Information

NPI Number	:	1194402032
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE MEDICAL INTERNET FOR HUMANITY

Provider Business Mailing Address
First Line	:	5908 RICHARD CARLTON BLVD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78727-7016
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 E SAINT JOHNS AVE STE 2620
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78752-2541
Country	:	US
Telephone Number	:	512-829-1742
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MARIYA GRAESTONE
Credential	:
Telephone Number	:	206-383-5104

Provider Enumeration Date	:	07/03/2023
Last Update Date	:	07/03/2023

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