MEDICARE: USA WELLNESS PROVIDERS CORP

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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	GZ379A	OTHER		MEDICARE PART B

General Provider Information

NPI Number	:	1477997013
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	USA WELLNESS PROVIDERS CORP

Provider Business Mailing Address
First Line	:	1050 LEE WAGENER BLVD
Second Line	:	230
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33315-3500
Country	:	US
Telephone Number	:	678-683-2223
Fax Number	:

Provider Business Practice Location Address
First Line	:	1050 LEE WAGENER BLVD
Second Line	:	230
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33315-3500
Country	:	US
Telephone Number	:	678-683-2223
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	ANGELO CORREA
Credential	:
Telephone Number	:	678-683-2223

Provider Enumeration Date	:	04/25/2013
Last Update Date	:	04/25/2013

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Directions to “USA WELLNESS PROVIDERS CORP ” Practice Location

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