MEDICARE: VISITING NURSE ASSOCIATION MOBILE CLINIC 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	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1407020225
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISITING NURSE ASSOCIATION MOBILE CLINIC INC

Provider Business Mailing Address
First Line	:	2400 SE MONTEREY RD
Second Line	:	SUITE 300
City	:	STUART
State	:	FL
Zip	:	34996-3351
Country	:	US
Telephone Number	:	772-286-1844
Fax Number	:	772-286-0738

Provider Business Practice Location Address
First Line	:	2400 SE MONTEREY RD
Second Line	:	SUITE 300
City	:	STUART
State	:	FL
Zip	:	34996-3351
Country	:	US
Telephone Number	:	772-286-1844
Fax Number	:	772-286-0738

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DONALD R CROW
Credential	:
Telephone Number	:	772-286-1844

Provider Enumeration Date	:	04/14/2008
Last Update Date	:	11/08/2013

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