MEDICARE: RAYPAR 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	208000000X	Pediatrics Physician	0069091	FL
2	261QR1300X	Rural Health Clinic/Center
3	208000000X	Pediatrics Physician

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457443202
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAYPAR INC

Provider Business Mailing Address
First Line	:	550 POPE AVE NW
Second Line	:	SUITE 100
City	:	WINTER HAVEN
State	:	FL
Zip	:	33881-4679
Country	:	US
Telephone Number	:	863-293-2144
Fax Number	:	863-293-3732

Provider Business Practice Location Address
First Line	:	550 POPE AVE NW
Second Line	:	SUITE 100
City	:	WINTER HAVEN
State	:	FL
Zip	:	33881-4679
Country	:	US
Telephone Number	:	863-293-2144
Fax Number	:	863-293-3732

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	KELLY A STANWOOD
Credential	:
Telephone Number	:	863-401-8516

Provider Enumeration Date	:	09/29/2006
Last Update Date	:	07/15/2014

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Directions to “RAYPAR INC ” Practice Location

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