MEDICARE: ADVANTAGE CLINIC 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	208D00000X	General Practice Physician	ME55707	FL
2	2084P0800X	Psychiatry Physician	ME55707	FL

General Provider Information

NPI Number	:	1558735290
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANTAGE CLINIC LLC

Provider Business Mailing Address
First Line	:	901 NORTHPOINT PKWY
Second Line	:	SUITE 302
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-1951
Country	:	US
Telephone Number	:	561-352-1587
Fax Number	:	561-420-0194

Provider Business Practice Location Address
First Line	:	901 NORTHPOINT PKWY
Second Line	:	SUITE 302
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-1951
Country	:	US
Telephone Number	:	561-352-1587
Fax Number	:	561-420-0194

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	DR. TAYLOR E GAINES
Credential	:	PHARM.D.,C.A.P.
Telephone Number	:	561-352-1587

Provider Enumeration Date	:	11/18/2015
Last Update Date	:	11/18/2015

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Directions to “ADVANTAGE CLINIC LLC ” Practice Location

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