MEDICARE: MEDIASSIST LLC

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	3336C0003X	Community/Retail Pharmacy	PH26186	FL

General Provider Information

NPI Number	:	1487097580
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDIASSIST LLC

Provider Business Mailing Address
First Line	:	2705 SW 142ND AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-8014
Country	:	US
Telephone Number	:	786-536-4746
Fax Number	:	786-536-5041

Provider Business Practice Location Address
First Line	:	2705 SW 142ND AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-8014
Country	:	US
Telephone Number	:	786-536-4746
Fax Number	:	786-536-5041

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JAVIER ORTIZ
Credential	:
Telephone Number	:	786-536-4746

Provider Enumeration Date	:	04/09/2013
Last Update Date	:	04/09/2013

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