MEDICARE: HEALTHSPAN PHYSICIANS, 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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1659782753
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHSPAN PHYSICIANS, LLC

Provider Business Mailing Address
First Line	:	12301 SNOW RD
Second Line	:	REVENUE CYCLE DEPARTMENT
City	:	PARMA
State	:	OH
Zip	:	44130-1002
Country	:	US
Telephone Number	:	866-265-8844
Fax Number	:	216-265-8890

Provider Business Practice Location Address
First Line	:	36711 AMERICAN WAY
Second Line	:
City	:	AVON
State	:	OH
Zip	:	44011-4062
Country	:	US
Telephone Number	:	440-937-2301
Fax Number	:	440-937-2345

Authorized Official
Title or Position	:	REVENUE CYCLE MANAGER
Name	:	MICHAEL MILECA
Credential	:
Telephone Number	:	216-265-8811

Provider Enumeration Date	:	05/12/2014
Last Update Date	:	09/22/2014

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