MEDICARE: VITAS HEALTHCARE CORPORATION MIDWEST

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	251G00000X	Community Based Hospice Care Agency
2	251G00000X	Community Based Hospice Care Agency	2002822	IL

General Provider Information

NPI Number	:	1902134299
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITAS HEALTHCARE CORPORATION MIDWEST

Provider Business Mailing Address
First Line	:	3046 CORPORATE WAY
Second Line	:	SUITE 1300
City	:	MIRAMAR
State	:	FL
Zip	:	33025-2011
Country	:	US
Telephone Number	:	305-350-6756
Fax Number	:	305-350-6993

Provider Business Practice Location Address
First Line	:	8 EXECUTIVE DR
Second Line	:	STE 150
City	:	FAIRVIEW HEIGHTS
State	:	IL
Zip	:	62208-1345
Country	:	US
Telephone Number	:	618-622-9073
Fax Number	:	618-622-9230

Authorized Official
Title or Position	:	SR. DIRECTOR
Name	:	JORGE MELERO
Credential	:
Telephone Number	:	305-350-6756

Provider Enumeration Date	:	11/24/2009
Last Update Date	:	11/28/2023

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