MEDICARE: AMEDISYS MARYLAND SUB, 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
1	251E00000X	Home Health Agency	HHA7045	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	201031840017	OTHER	MD	TRICARE HEALTH NET
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295789360
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMEDISYS MARYLAND SUB, LLC

Provider Business Mailing Address
First Line	:	3854 AMERICAN WAY STE A
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-4897
Country	:	US
Telephone Number	:	225-292-2031
Fax Number	:	225-295-9678

Provider Business Practice Location Address
First Line	:	134 INDUSTRY LN STE 3
Second Line	:
City	:	FOREST HILL
State	:	MD
Zip	:	21050-3243
Country	:	US
Telephone Number	:	410-420-6412
Fax Number	:	410-420-6419

Authorized Official
Title or Position	:	SVP TAX
Name	:	TRAVIS MIGLICCO
Credential	:
Telephone Number	:	225-299-3803

Provider Enumeration Date	:	05/21/2006
Last Update Date	:	11/10/2025

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