MEDICARE: EASTERN MEDICINE HEALTH CENTER

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	174400000X	Specialist	LMT 42039	FL
2	171100000X	Acupuncturist	AP 2523	FL

General Provider Information

NPI Number	:	1477715993
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EASTERN MEDICINE HEALTH CENTER

Provider Business Mailing Address
First Line	:	280 PATTERSON RD
Second Line	:	STE.# 1
City	:	HAINES CITY
State	:	FL
Zip	:	33844-6261
Country	:	US
Telephone Number	:	863-421-2900
Fax Number	:	863-421-2990

Provider Business Practice Location Address
First Line	:	280 PATTERSON RD
Second Line	:	STE.# 1
City	:	HAINES CITY
State	:	FL
Zip	:	33844-6261
Country	:	US
Telephone Number	:	863-421-2900
Fax Number	:	863-421-2990

Authorized Official
Title or Position	:	ACUPUNCTURIST
Name	:	LAN WANG
Credential	:
Telephone Number	:	863-421-2900

Provider Enumeration Date	:	06/26/2008
Last Update Date	:	06/26/2008

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1881856326 — LAN WANG
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Directions to “EASTERN MEDICINE HEALTH CENTER ” Practice Location

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