MEDICARE: YOUR GOOD HEALTH MEDICAL GROUP PA

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	207R00000X	Internal Medicine Physician	OS0003793	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	K9758	OTHER	FL	MEDICARE PTAN

General Provider Information

NPI Number	:	1316970981
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUR GOOD HEALTH MEDICAL GROUP PA

Provider Business Mailing Address
First Line	:	11000 PROSPERITY FARMS RD
Second Line	:	SUITE 206
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-3462
Country	:	US
Telephone Number	:	561-622-4646
Fax Number	:	561-775-8625

Provider Business Practice Location Address
First Line	:	11000 PROSPERITY FARMS RD
Second Line	:	SUITE 206
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-3462
Country	:	US
Telephone Number	:	561-622-4646
Fax Number	:	561-775-8625

Authorized Official
Title or Position	:	OWNER
Name	:	DAVID VASTOLA
Credential	:	DO
Telephone Number	:	561-622-4646

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	09/18/2009

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Directions to “YOUR GOOD HEALTH MEDICAL GROUP PA ” Practice Location

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