MEDICARE: LIFE SOLUTIONS OUTPATIENT 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	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1427441682
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE SOLUTIONS OUTPATIENT CORPORATION

Provider Business Mailing Address
First Line	:	901 NORTHPOINT PKWY
Second Line	:	SUITE 303
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-1951
Country	:	US
Telephone Number	:	954-746-8232
Fax Number	:	954-746-8231

Provider Business Practice Location Address
First Line	:	901 NORTHPOINT PKWY
Second Line	:	SUITE 303
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-1951
Country	:	US
Telephone Number	:	954-746-8232
Fax Number	:	954-746-8231

Authorized Official
Title or Position	:	CEO
Name	:	TAYLOR GAINES
Credential	:
Telephone Number	:	855-454-3376

Provider Enumeration Date	:	03/12/2015
Last Update Date	:	02/04/2016

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