MEDICARE: ANGELS MEDICAL 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	208VP0014X	Interventional Pain Medicine Physician	27570	SC

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	:	1780052662
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGELS MEDICAL LLC

Provider Business Mailing Address
First Line	:	PO BOX 16584
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-4060
Country	:	US
Telephone Number	:	803-424-5879
Fax Number	:

Provider Business Practice Location Address
First Line	:	718 LAFAYETTE AVE
Second Line	:
City	:	CAMDEN
State	:	SC
Zip	:	29020-3522
Country	:	US
Telephone Number	:	803-424-5879
Fax Number	:

Authorized Official
Title or Position	:	MANAGING DIRECTOR
Name	:	GEORGE BITTING
Credential	:	M.D.
Telephone Number	:	803-424-5879

Provider Enumeration Date	:	09/09/2015
Last Update Date	:	03/31/2016

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Directions to “ANGELS MEDICAL LLC ” Practice Location

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