MEDICARE: MEDOPTIONS, INC.

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	302F00000X	Exclusive Provider Organization	569338-8	FL

General Provider Information

NPI Number	:	1386888162
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDOPTIONS, INC.

Provider Business Mailing Address
First Line	:	3924 NW 167TH ST
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33054-6240
Country	:	US
Telephone Number	:	800-969-4965
Fax Number	:	786-515-9241

Provider Business Practice Location Address
First Line	:	3924 NW 167TH ST
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33054-6240
Country	:	US
Telephone Number	:	800-969-4965
Fax Number	:	786-515-9241

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOHN SANTANA
Credential	:
Telephone Number	:	800-969-4965

Provider Enumeration Date	:	04/24/2009
Last Update Date	:	04/24/2009

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