MEDICARE: HAILE MEDICAL GROUP PA

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1851433197
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAILE MEDICAL GROUP PA

Provider Business Mailing Address
First Line	:	4750 SW 91ST DR STE A
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32608-8140
Country	:	US
Telephone Number	:	352-367-9602
Fax Number	:

Provider Business Practice Location Address
First Line	:	4750 SW 91ST DR STE A
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32608-8140
Country	:	US
Telephone Number	:	352-367-9602
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MS. NICHOLE OSBORNE
Credential	:
Telephone Number	:	352-367-9602

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	02/25/2009

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Directions to “HAILE MEDICAL GROUP PA ” Practice Location

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