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NPI Code Detail

MEDICARE: AEGIS GROUP PRACTICE LLC

MEDICARE: AEGIS GROUP PRACTICE 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
1225X00000XOccupational Therapist
2235Z00000XSpeech-Language Pathologist
3225100000XPhysical Therapist

General Provider Information

NPI Number : 1275392458
Entity Type Code : Organization
Provider Name (Legal Business Name) : AEGIS GROUP PRACTICE LLC
Provider Business Mailing Address
First Line : 4933 OLD GREENWOOD RD
Second Line :
City : FORT SMITH
State : AR
Zip : 72903-6906
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 9684 GOODMAN RD
Second Line :
City : OLIVE BRANCH
State : MS
Zip : 38654-1726
Country : US
Telephone Number : 479-201-6091
Fax Number :
Authorized Official
Title or Position : CREDENTIALING
Name : TRACY MCCALL
Credential :
Telephone Number : 479-201-6091
Provider Enumeration Date : 03/18/2024
Last Update Date : 03/18/2024

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Directions to “AEGIS GROUP PRACTICE LLC ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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