MEDICARE: COLUMNA

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	207XS0117X	Orthopaedic Surgery of the Spine Physician	ME105711	FL

General Provider Information

NPI Number	:	1235430513
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLUMNA

Provider Business Mailing Address
First Line	:	3618 LANTANA RD STE 201
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33462-2247
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3618 LANTANA RD STE 201
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33462-2247
Country	:	US
Telephone Number	:	561-296-2220
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	THOMAS ROUSH
Credential	:
Telephone Number	:	561-531-2401

Provider Enumeration Date	:	11/03/2010
Last Update Date	:	11/03/2010

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Practice Location Address:

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1750575932 — MRS. SUSAN RICE MOLINA PA-C
Practice Location Address:

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Practice Fax:

1447662150 — DR. MEGAN ELLINGBURG SHIRLEY D.O.
Practice Location Address:

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1164972964 — AGR RESEARCH, LLC
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Directions to “COLUMNA ” Practice Location

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