MEDICARE: L.O.T. HEALTH SERVICES, INC.

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	1041C0700X	Clinical Social Worker	SW8609	FL
2	174400000X	Specialist	ME108802	FL
3	207R00000X	Internal Medicine Physician	ME49236	FL
4	207RC0000X	Cardiovascular Disease Physician	ME108802	FL
5	208000000X	Pediatrics Physician	ME68559	FL
6	208D00000X	General Practice Physician
7	363AM0700X	Medical Physician Assistant	PA9103904	FL
8	363LF0000X	Family Nurse Practitioner	ARNP9276312	FL
9	261QM1300X	Multi-Specialty Clinic/Center	ME108802	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619367976
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	L.O.T. HEALTH SERVICES, INC.

Provider Business Mailing Address
First Line	:	11924 FOREST HILL BLVD
Second Line	:	SUITE 10A-243
City	:	WELLINGTON
State	:	FL
Zip	:	33414-6256
Country	:	US
Telephone Number	:	561-693-5143
Fax Number	:

Provider Business Practice Location Address
First Line	:	845 PALM BEACH RD
Second Line	:
City	:	SOUTH BAY
State	:	FL
Zip	:	33493-2037
Country	:	US
Telephone Number	:	561-693-5143
Fax Number	:	561-245-9150

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. MAGALI RODRIGUEZ-LOUIS
Credential	:
Telephone Number	:	561-693-5143

Provider Enumeration Date	:	01/26/2015
Last Update Date	:	03/30/2021

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