MEDICARE: EADS MEDICAL PRACTICE

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	207Q00000X	Family Medicine Physician	OS0007549	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285668137
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EADS MEDICAL PRACTICE

Provider Business Mailing Address
First Line	:	800 STERTHAUS AVE STE A
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-5132
Country	:	US
Telephone Number	:	386-673-5411
Fax Number	:	386-673-2285

Provider Business Practice Location Address
First Line	:	800 STERTHAUS AVE STE A
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-5132
Country	:	US
Telephone Number	:	386-673-5411
Fax Number	:	386-673-2285

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ELIZABETH ANNE EADS
Credential	:	D.O.
Telephone Number	:	385-673-5411

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	01/25/2008

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Directions to “EADS MEDICAL PRACTICE ” Practice Location

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