MEDICARE: MEDICAL HEALING ARTS CENTER,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	207R00000X	Internal Medicine Physician		FL

General Provider Information

NPI Number	:	1700073582
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL HEALING ARTS CENTER,LLC

Provider Business Mailing Address
First Line	:	3000 MARION COUNTY RD
Second Line	:
City	:	WEIRSDALE
State	:	FL
Zip	:	32195-5168
Country	:	US
Telephone Number	:	352-750-5500
Fax Number	:	352-347-5876

Provider Business Practice Location Address
First Line	:	17820 SE 109TH AVE STE 104
Second Line	:
City	:	SUMMERFIELD
State	:	FL
Zip	:	34491-8968
Country	:	US
Telephone Number	:	352-347-1873
Fax Number	:	352-347-5876

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. GLORIA AUSTIN
Credential	:
Telephone Number	:	352-347-1873

Provider Enumeration Date	:	09/26/2007
Last Update Date	:	09/26/2007

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