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NPI Code Detail

MEDICARE: EZDOCTORSRX.COM INC.

MEDICARE: EZDOCTORSRX.COM 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
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1639461692
Entity Type Code : Organization
Provider Name (Legal Business Name) : EZDOCTORSRX.COM INC.
Provider Business Mailing Address
First Line : 1621 WILLOW ST
Second Line :
City : VINCENNES
State : IN
Zip : 47591-4211
Country : US
Telephone Number : 812-882-2400
Fax Number : 812-882-2422
Provider Business Practice Location Address
First Line : 1621 WILLOW ST
Second Line :
City : VINCENNES
State : IN
Zip : 47591-4211
Country : US
Telephone Number : 812-882-2400
Fax Number : 812-882-2422
Authorized Official
Title or Position : OFFICE MANAGER
Name : MRS. LISA D STEEL
Credential : CPC
Telephone Number : 812-882-2400
Provider Enumeration Date : 05/10/2011
Last Update Date : 05/10/2011

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