MEDICARE: LOVING CARE PRIMARY MEDICAL SERVICES 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	208D00000X	General Practice Physician	ME61755	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	:	1396096640
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOVING CARE PRIMARY MEDICAL SERVICES INC

Provider Business Mailing Address
First Line	:	7445 NW 57TH ST
Second Line	:
City	:	LAUDERHILL
State	:	FL
Zip	:	33319-2101
Country	:	US
Telephone Number	:	954-726-2262
Fax Number	:	954-726-7048

Provider Business Practice Location Address
First Line	:	7445 NW 57TH ST
Second Line	:
City	:	LAUDERHILL
State	:	FL
Zip	:	33319-2101
Country	:	US
Telephone Number	:	954-726-2262
Fax Number	:	954-726-7048

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PETER ELIAS HADEED
Credential	:	M.D
Telephone Number	:	954-726-2262

Provider Enumeration Date	:	09/26/2012
Last Update Date	:	10/17/2012

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