MEDICARE: TOTAL SENIOR HEALTH CARE MOBILE PHYSICIAN SERVICES 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	207QG0300X	Geriatric Medicine (Family Medicine) Physician
2	207RG0300X	Geriatric Medicine (Internal Medicine) Physician

General Provider Information

NPI Number	:	1790871424
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOTAL SENIOR HEALTH CARE MOBILE PHYSICIAN SERVICES LLC

Provider Business Mailing Address
First Line	:	3368 WOODS EDGE CIR
Second Line	:	SUITE 104
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34134-3437
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3368 WOODS EDGE CIR
Second Line	:	SUITE 104
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34134-3437
Country	:	US
Telephone Number	:	239-390-2032
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. DONALD JOHN DIPASCO
Credential	:	M.D.
Telephone Number	:	239-390-2032

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	01/13/2011

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