MEDICARE: AEGIS GROUP PRACTICE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	235Z00000X	Speech-Language Pathologist
2	225100000X	Physical Therapist
3	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1578034484
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AEGIS GROUP PRACTICE LLC

Provider Business Mailing Address
First Line	:	1000 FIANNA WAY
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72919-9008
Country	:	US
Telephone Number	:	479-201-6089
Fax Number	:

Provider Business Practice Location Address
First Line	:	2115 2ND ST SW
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55902-2442
Country	:	US
Telephone Number	:	800-444-6845
Fax Number	:	479-478-2852

Authorized Official
Title or Position	:	VP FINANCE
Name	:	MICHAEL MCOLVIN
Credential	:
Telephone Number	:	479-201-2000

Provider Enumeration Date	:	12/17/2018
Last Update Date	:	06/17/2026

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Directions to “AEGIS GROUP PRACTICE LLC ” Practice Location

Language	Start Address	Practice Location

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