MEDICARE: ACT CORPORATION

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	305R00000X	Preferred Provider Organization		FL

General Provider Information

NPI Number	:	1306974696
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACT CORPORATION

Provider Business Mailing Address
First Line	:	1350 ALMOND ST
Second Line	:
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-3802
Country	:	US
Telephone Number	:	386-774-2807
Fax Number	:	386-236-3137

Provider Business Practice Location Address
First Line	:	1350 ALMOND ST
Second Line	:
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-3802
Country	:	US
Telephone Number	:	386-774-2807
Fax Number	:	386-236-3137

Authorized Official
Title or Position	:	CLINICAL SPECIALIST V
Name	:	MRS. DEBORAH PATTERSON WALKER
Credential	:	B.S.
Telephone Number	:	386-236-1812

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	07/21/2022

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Directions to “ACT CORPORATION ” Practice Location

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