MEDICARE: UNITED HOSPICE 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	363LF0000X	Family Nurse Practitioner
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1760427819
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNITED HOSPICE SERVICES, INC.

Provider Business Mailing Address
First Line	:	2501 PARKVIEW DR
Second Line	:	SUITE 330
City	:	FORT WORTH
State	:	TX
Zip	:	76102-5824
Country	:	US
Telephone Number	:	682-432-0459
Fax Number	:	682-432-0471

Provider Business Practice Location Address
First Line	:	2501 PARKVIEW DR
Second Line	:	SUITE 330
City	:	FORT WORTH
State	:	TX
Zip	:	76102-5824
Country	:	US
Telephone Number	:	682-432-0459
Fax Number	:	682-432-0471

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	MR. SAMMY LEE STONE
Credential	:
Telephone Number	:	682-432-0459

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	07/29/2008

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