MEDICARE: HOSPITAL SPECIALISTS

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	282N00000X	General Acute Care Hospital	ME103761	FL

General Provider Information

NPI Number	:	1194968396
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOSPITAL SPECIALISTS

Provider Business Mailing Address
First Line	:	2041 SEAGIRT BLVD APT 4G
Second Line	:
City	:	FAR ROCKAWAY
State	:	NY
Zip	:	11691-5803
Country	:	US
Telephone Number	:	347-246-7494
Fax Number	:

Provider Business Practice Location Address
First Line	:	4466 SWILCAN BRIDGE LN N
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32224-5617
Country	:	US
Telephone Number	:	904-962-2694
Fax Number	:

Authorized Official
Title or Position	:	RESIDENT
Name	:	MR. GREGORY G PAVLAT
Credential	:	M.D.
Telephone Number	:	347-246-7494

Provider Enumeration Date	:	04/17/2009
Last Update Date	:	04/17/2009

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Directions to “HOSPITAL SPECIALISTS ” Practice Location

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